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Benefits of GP access policies are 'unclear'

The impact of political pledges to boost GP access through extended hours or 48 hour appointment targets remain ‘unclear’ and should be more robustly questioned by the public, an analysis has concluded

A BMJ analysis of political pledges to improve GP access, currently being touted by both Labour and the Conservatives in the run up to the 2015 general election, has highlighted the lack of pilot evidence to demonstrate the plans will be effective or achievable.

The analysis calls into question whether pledges are based on what’s best for the NHS or if they are simply electioneering.

It states: ‘The aims and rationale of the policies outlined by the Conservative and Labour parties do not seem explicit. One aim is undoubtedly to win election votes. But the aims for the NHS and for patients are less clear.’

The analysis questions whether the Conservatives’ aim of providing seven-day access or Labour’s policy of guaranteed GP appointments within 48 hours will reduce pressure on other services.

It states: ‘It is unknown whether improvements in access to general practice over time are associated with reduced use of other services, or indeed health outcomes and healthcare costs. The unintended effects, which may include supply induced demand, are also unclear.

The analysis also notes that ‘interpersonal’ elements of care, such as continuity with your preferred GP, are most strongly associated with satisfaction, and patients will often forgo more greater access in order to see their preferred GP.

GPC chair Dr Chaand Nagpaul said of the findings: ‘It is disappointing that despite the promises made at the start of the general election campaign, politicians are continuing to play games with the future of GP services rather than working on long term solutions to the challenges facing patient care.

‘This BMJ study reinforces the BMA’s concerns that evidence is lacking behind current political pledges and that there is little likelihood of achieving the increases in GP numbers proposed within the next Parliament.’

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Readers' comments (11)

  • And now we move on to BMJ analysis of bear toileting activities!

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  • Azeem Majeed

    It is important that new initiatives such as extended GP access schemes are rigorously evaluated to ensure that they are clinically effective and cost effective, and do not have any unintended negative consequences.

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  • It is important that GPs have some autonomy returned to them and are left to develop and run their practices as they see fit. No one scheme will suit all areas and we should be left alone

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  • Vinci Ho

    The words you are looking for are:

    Made compulsory

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  • How true Vince

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  • Increased access will be just the same as adding another lane to an already very busy motorway.

    'Traffic' is already grid-locked on the motorway and the side roads. How could such a policy be put in place at a time of diminishing resources for health and social care

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  • Ivan Benett

    Congratulations Azeem , on this paper, it stricks exactly the right note. A welcome addition to the debate.
    Extended hours are clearly likeed by those who use them. There seem to be modest impact on urgent care activity. But the schemes are still too early to be fully evaluated, and the potential of increased capacity is great.
    The motor way analagy is clearly wrong, and so is the bear defeacation habit.
    Improving access provides the opportunity to prevent deteriorating illness and manage both palnned and urgent care demand....err actually the whole of Primary Care.
    Yes, it needs funding, Yes it needs workforce, Yes, working beyond contracted hours needs to be optional for individuals. Yes extended hours needs to be separately commissioned, Yes you need to work in large groupings etc etc, but give it a chance boys (I'm guessing most of the nay-sayers are boys, by their tone).

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  • Ivan, I admire your persistence regarding the virtues of extended access but we have to face the realities of the funding available in a state system. The challenge fund is ultimately removing funding from core services and is so obviously Politically motivated. It is a want not a need. Until we as a nation are prepared to spend more of our GDP on health this really is not affordable. PS I have done a couple of weekend sessions and can say they were not used to capacity and did not prevent one ED attendance-although I did enjoy the luxury of 15min appointments.

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  • Azeem Majeed

    Ivan Benett | Salaried GP | 02 April 2015 10:11am

    Thanks Ivan. It's always good to get some positive comments (in fact, it's good to get ANY comments, positive or negative).

    We have published a number of papers (listed in the references to the BMJ article) which consistently show that practices with better access scores perform better on a number of health outcome measures.

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  • Peter Swinyard

    Well, we had "advanced access" under the previous government - 48 hour guarantee etc etc.
    Is there any evidence it worked?
    My patients hated it as they could not forward-book appointments and we abandoned it.
    I suppose evidence-based policy is kind of unlikely. But is there any evidence of this political posturing winning votes? I think equally unlikely.
    So stop it.

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