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Government's extended access strategy will threaten continuity of care, academics warn

Exclusive The Government’s ‘populist fixation’ with GP opening hours may hamper continuity of care and even lead to more A&E admissions, leading academics have said.

Prime Minister David Cameron today announced a series of new schemes to extend access through a £50m fund, which will see more than 1,000 GP practices trialling 24-hour telephone access and weekend surgeries.

This was announced alongside health secretary Jeremy Hunt’s ‘Proactive Care Programme’ - a series of plans for how GPs will keep vulnerable older people out of hospital, mainly consisting of his previously announced ‘named GP’ scheme and unplanned admissions DES.

However, academics have warned that the two strategies of extending access for working people and providing continuity of care to avoid hospital admissions may work against each other.

Professor Richard Baker, a professor of healthcare quality at the University of Leicester, who has studied the relationship between continuity of care and A&E admissions, warned that general practice was ‘overstretched’, leading to unintended consequences from asking practices to focus on extending access.

He said: ‘I think that continuity of care is likely to decline in some of these schemes, and reduced continuity is associated with more admissions - particularly among patients with complex conditions. So there are likely to be unintended consequences - because asking general practice to do something extra without new capacity will almost certainly mean that other elements of care will not occur.’

Professor Baker said the important thing was for the Government to thoroughly evaluate the scheme.

He said: ‘I would be very disappointed if there wasn’t a really serious attempt to find out whether they are working or not. In some ways it is a real opportunity to find out if we could do things better - but the evaluations must also investigate what has got worse.’

Meanwhile professor Martin Roland, professor of health services research at the University of Cambridge and a part-time GP in Cambridge, warned that the Government’s ‘populist fixation’ with opening hours would compromise care.

He said: ‘This flies in the face of what we increasingly know to be important about continuity of care.’

‘Getting to see any old doctor is at times important for patients, but many people want to see a doctor they know and doctors find it very hard to deliver high quality care to patients - especially complex ones - who they don’t know. Practices need to be organised to provide this, and not just be open for longer hours. This is fully in line with the “responsible doctor” agenda that the secretary of state is already promoting, but seems to be at odds with the £50m prime minister’s challenge which is all about opening hours.’

‘Doctors need continuity to provide safe care, and our increasingly complex elderly patients need it too. When will the Government drop this populist fixation with opening hours?’

Health secretary Jeremy Hunt said: ‘Extending GP opening hours and offering more services online will also make it far easier for millions of hardworking people and their families to fit seeing a GP around their busy lives.’

Readers' comments (26)

  • Vinci Ho

    When will the government drop this populist fixation with opening hours?’
    Answer is : Never
    If you think the pilot will have something good as well as something bad, I am sorry that is naive. Reality is everything is going to be good with the pilot.
    Why? Remember Ministry of Truth in 1984. Propaganda is so so important , mate .

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  • Vinci Ho

    Pilot result will be an analogy to a pharmaceutical company's final trial result of a forthcoming new drug.
    We all know what it is........

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  • Why the loss of continuity?The patients who will be attending during extended hours will be coming in as acutes not "chronics" who will prefer to wait to be seen by their usual GP.It will be no different from GP co-ops which have been running for several decades.Never had anyone whinging about loss of continuity then!

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  • This money would be best spent on public health campaigns in schools, colleges and workplaces to educate the British public about what they really need to see a doctor for. Medicine is at risk of diluting itself to becoming a service for reassuring the well, not treating the sick. Our a&e colleagues are run ragged with high attendance rates but are the people whom the government wants seen in GP rather than casualty actually needing to see a doctor at all? In many cases no. We are trained to treat disease and sickness, yet with increased access comes the inevitable "should I be worried about this?" for trivial complaints. Doctors must not compromise their own families, well being and work-life balance by becoming slaves to a 24/7 "drive thru" approach to seeking medical attention.

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  • Anon 8.28
    If your argument holds up... Who will staff the extended hours?
    it can not be the same doc who's worked all day
    So will have to be newly employed ?
    I doubt funding will cover that cost.
    Working shifts is fine as long it does not compromise
    day time cover.
    If practices were paid per patient seen..
    Capacity could be tailored to meet demand...
    but as usual ... It's a funding issue .
    ( not forgetting that most issues can be left to the morning and genuine emergency need to be in casualty
    )
    If the Gov wants capacity over 12 hours
    I think the profession should engage ..
    But evaluate it with a proper trial .

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  • @above who wrote "Who will staff the extended hours?it can not be the same doc who's worked all day"
    There's plenty of capacity in the system.Aren't we told that part-timers form the majority of GP workforce nowadays.So why not get them to do the extended hours?It's either that or you pay someone else to do it for you.With practices standing to lose significant income from QOF cutbacks and PMS reviews expect many part time GP partners suddenly re-evaluating their commitments to family and "portfolio work" and returning to do some additional sessions.

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  • Anonymous | 14 April 2014 10:22pm

    "expect many part time GP partners suddenly re-evaluating their commitments to family and "portfolio work" and returning to do some additional sessions."

    Considering this is mainly female GP partners, the logical consequence of working becoming too expensive is to stop working and become a full time mum and find other part time job opportunities. As this is a highly skilled group they will find other niches but general practice will struggle without them.

    As long as governments speak the language of want and we as a profession talk about need, we will be at cross purposes. One group has to change.

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  • anonymous 10:22

    Well said. Women part timers have other options as they are often not the principal wage earner.

    Part timers have made a conscious decision to work less, often because they have family responsibilities. Good Luck in enticing them to work unsocial hours.

    Make it uneconomic to work and they won't.

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  • Let's see. For an average practice to provide one GP:

    Extra hours during the weekdays 1.5hrs x5=7.5hrs
    Extra hours during the weekends 12x2 = 24hrs
    Overall extra week = 31.5house

    Unsociable hours GP pay/hour =£90/hour
    Unsociable reception pay/hour= £16/hour

    Overall annual cost to fund the service in a year to provide one GP and a receptionist
    (90+16)x31.5x52=£190008/year.

    But this is without overhead costs, admin support costs, it cost, holiday, study entitlement etc so call it £200k/year for an average practice (7500 ish lost size according to previous pulse article)

    Cost per patient 200,000/7500 = £26.66 more/patient/year

    Uk population 2012 as per office of national statistics 63.7million

    Over all cost in a year 1.7billion more/year.

    Seriously? Government is not going to increase primary care budget by 1.7 billion/year. See how pitiful the 50 million pounds sounds now. And that's the money we've had to jump through hoops to beg for, let alone a nominal increase in global sum.

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  • suprise surprise extended hours is another wasteful scheme diverting resoirces from patient care..we should reject it outright..of course there are always the useful idiots who do anything for thinly veiled bribes..how many people will suffer for this piece of pre election public relations trash(funny that phrase p.r.has the same shorthand as per rectum..or maybe that explains a lot)because of yet more diversion of desperately need frontline care resources into this and other wasteful lunacy like darzi qof private finance initiative internal'market' etc etc etc..the list of insanity rolls on to pluto.
    please please can we have proper leadership that rejects this and refuses to co operate with all the other deranged incompetent nonsense before it is too late..our younger colleagues deserve it.

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