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GP appointment waiting times to be published under new access drive

GP practices are to have their waiting times for appointments published under a drive to improve access, says NHS chief executive Simon Stevens.

Speaking in front of the cross-party House of Commons Public Accounts Committee today, Mr Stevens said that NHS England would begin collecting waiting times data this year.

Mr Stevens added that he wanted to see access to GP appointments improving as a result of the increased investment into the general practice workforce.

At the hearing, that followed a critical report from the National Audit Office that said the Government had a ‘crude’ understanding of current demand and capacity.

 But Mr Stevens said that NHS England was significantly increasing its measurements of general practice, including a scheme for practices to report their workload, and an audit of waiting times.

He told MPs: ‘We want to have more information on the availability of GP appointments for routine conditions, and we are going to start collecting those data through the course of this year.

‘We’re going to publish those so people can see what waiting times are, I think that will be good for patients, it will be good for GPs, actually.’

He added that, while NHS England recognises general practice is under significant strain, it was also receiving investment – particularly in new workforce - and ‘therefore it’s reasonable to expect, on the back of that, improved access’.

Stevens added that this year they would also introduce a ‘GP practice workload tool to measure what is happening inside primary care’.

He told the PAC that the lack of this data on workload pressures had contributed to historic underfunding and was one of the reasons ‘GP services have lost out compared to other parts of the NHS’.

Pulse has asked NHS England to clarify whether waiting times data would be published at individual practice level.

GP leaders said no details had been worked out and it would not be straightforward. GPC deputy chair Dr Richard Vautrey told Pulse: 'Practices operate in varying ways and there are patients who want to wait to see a GP of their choice, how do you qualify that and compare patients who will happily see any GP for a particular episode of care?'

The National Audit Office report highlighted some areas of the country where practices were closing once a week or more during core hours, despite in some cases also receiving funding from the extended access DES.

The panel today clarified that 75% of these practices were located in roughly 50 of the 211 CCGs in England.

NHS England’s director of commissioning development Rosamond Roughton said these patterns were ‘concentrated in very particular parts of the country’ without obvious reason.

She added there was some confusion in practices' response - as follow up queries with some practices revealed many still provide appointment booking, or prescriptions collection services, but that publishing the data had impacted their behaviour.

Ms Roughton said: ‘In many parts of the country [practices] saw the data and were taken aback: "Why are some practices closing for half day when we’re not?”

‘In some ways we know peer pressure is one of the ways we can see change happen.'

She said NHS England would not be afraid to also use contractual penalties to change these behaviours, but intended to take a ‘supportive’ approach initially as many of these practices have acute workforce difficulties.

RCGP chair Professor Helen-Stokes Lampard said that 'data can be a very useful tool in improving patient care' but 'data on waiting times should not be used as a measure of performance, as this will be affected by too many variables'.

'Average waiting times will be influenced by population demographics and deprivation levels in an area, for example, as well as factors at a practice level, such as recruitment difficulties,' she said.

She added: 'The College has not shied away from highlighting the issue of soaring waiting times for patients to see their GP – and we want to work with NHS England and others to improve the service for patients, right across the NHS...

It is essential that any data derived from general practice is used in a meaningful way to inform and improve the health service and the care that patients receive, and is not simply used as a stick to beat hard working GPs and our teams with.

Readers' comments (48)

  • @john - most of our docs do 5-6 sessions. over 3-4 days and if you do an early you leave early - we strive for continuity which is probably our biggest issue - no real problems with stress/burnout (at least from work - usual number of divorces/ill parents/wayward kids). income is above average for the area. tax is too much....is it perfect? no - we need to actively signpost more to alternative services.. if there are any.. - also middle class area with lots of pushy parents who know their rights.. i think we should try harder for 15m appointments or longer with complex multicomorbid pts. - we could really do with some better hospital avoidance measures...i think we need to merge/grow with other practices and take on more non core work (and the income) having said all that - i visited a practice this morning - single hander - 1 person in waiting room. they use the doctor first triage - handle everyone on the phone - great NP great pharmacist great reception. they werent stressed. i really think some practices need to learn from others.. one of the things ive started saying to some colleagues in other practices - is it isnt general practice that is the problem - its the way you run your practice..(and sometimes some of their pain the ass senior partners who are coasting to retirement - yes it happens)

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  • "NHS England recognises general practice is under significant strain, it was also receiving investment – particularly in new workforce - and ‘therefore it’s reasonable to expect, on the back of that, improved access’."

    What investment in workforce - Paramedics and pharmacists? But Simon Stevens only mentions access to GPs will be published. Access to paramedics and pharmacists has improved but not GPs.

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  • Just like adding an extra lane to a motorway it just gets immediately filled. So we have smart motorways. When will we address demand? You cannnot realistically increase access in one parliament without flogging your current workload even more. Does the NHS chief exec even know how long it takes to train a GP?

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  • @6:02.. problem is - there is evidence once to get to a certain level - you have seen everyone. including johhny with the sore throat for 9 mins. you cant see him with no sore throat.. realistically we need more funding, more GPs, more community services, better hsoiptal avoidance and more social care.. however.. some practices put their heads in the sand re access.. its often custom and practice and outdated ways of working.

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  • It all boils down to funding, and how much of a gut you're prepared to bust.

    Our practice income is low per capita -has been for ages, we shout and no-one listens. We're small rural and responsive, open long hours and see patients quickly and respond to surges in patient demand. Our income has been cut massively -our GPs need more pay than 5-6 sessions a week would generate unlike in Mr Devil's practice.
    With more income to attract staff, decrease our list sizes from over 2000 per GP we could flourish.

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  • Can we have a competition as to who can have the longest waiting time then? Prize being a week off at the destination of your choice as you are obviously so snowed under?

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  • Dear Devil's advocate,
    " im sat here and I look at our appointments and at 5pm we have 30 free. ive just seen little johnny with a sore throat. his dad rang about 9 mins ago - got an appointment and hes been seen and sent on his way (without antibiotics)"

    ....and no doubt you think this is good. What are the long term behavioural and system wide effects of offering a 9 minute waiting time service for conditions that need no formal medical input?

    The NHS is suffering from being funded as a needs led service but being managed on demand led terms. What you are doing simply fuels the beast. That father will now expect a 9 miniute response time for any future trivia that may befall his family and even more rapidly for something that might actually have clinical relevance. Well done for encouraging the worried well.

    What you should have done is provided advice via an intermediary (receptionist, phone call, triage, nurse, duty Dr assessment, on-line, web tool, app, e-mail etc) and avoided wasting the time of an experienced professional.

    You may think you have cracked it at the moment but those who inherit your patients will pay the price. As you say in a later posting "we need to actively signpost more to alternative services." but that can sometimes be uncomfortable, so its much easier to offer johnny the appointment. I agree with you that the problem is the way many GPs run their practices. Not enough say no.


    Regards
    Paul C

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  • The biggest time constraint is the complete transfer of all hospital inpatient and outpatient follow up to primary care with no funding. This means there are hours of letters, results, follow ups and medication issues to do each day, much of it generated elsewhere and difficult to avoid as once seen it is difficult to unseen, and often the bomb (missed or potential cancer/renal failure GP to f/up) is buried in a pile of rubbish.

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  • Why not look at historical models??I would,as a child in 1956 age 4 look out of my freezing bedroom window in cotton mill damaged NE Lancs and see a queue of patients,pleased with a free at the point of access service.coming to see my dad the GPat opening.,in the surgery on the ground floor of our terraced house.Clad in clogs ,,headscarves covering curlers,these folks had specific industrial illness ,tuberculosis was rife, cardiac failure 2y to what is now treatable cardiac valve disease....home deliveries (with flying squads)...a highly dedicated local DGH,and much input from the local parish priest....No mobiles,no IT, hardly any cars,rag and bone men and back street life galore (we lived above the surgery)...I never realised how much my father got out of bed pre -paramedics...neither do my children realise the same was of me and my husband as recently as the 90's.
    In order to keep supporting the community in which we still somehow live and work,in what used to be an honourable profession..we have had to morph.
    Each month brings a new set of rules,targets...dizzying for the 60plus...challenging...to manoeuvre around..and why?What about the Hippocratic Oath we declared on graduation.Yes we see the unreasonable repeat offender with minor discomfort,but can do much to sort and sift efficiently.....What is in order now is a little public gratitude and awareness ,teaching even in schools of what constitutes good health ,discipline....and the nature of real medical emergency.I feel strongly that the service could be effective if run on the lines of Boots,or Tescowith one central directorate instead of multiple local CCGs with different objectives and an expensive managerial led system for ensuring quality achievement and payment...more complex surprisingly than the clinical job itself(fact little realised by the public).
    .OK I've been quiet all my working life as a GP,brought up 4 children with a huge amount of professional uncertainty.....and am delighted to have 8 grandchildren...but it continues to be a slog ,no easier now than then.

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  • Where does one start?

    1 Practices that have better access figures tend to be better funded. There are too many funding formulae that have created inequities. Access comparisons should be not be interpreted without comparing funding, and practice funding should compare like with like. The funding per patient in each practice should not include reimbursements like notional/cost rent, rent and rates etc
    2 Demographics have significant impact on workload, and there are significant differences between demand and need
    3 The emphasis on access over continuity is destroying General Practice. As an ex-partner now doing locums, I see wide variation in practices. While patients say that it is hard to see a doctor, what they would really value is being able to see the same doctor regularly and to build up a relationship with them. There is no recognition that the one of the main roles of General Practice is to manage chronic disease.
    4 Practices offering the best care (as perceived by patients and using appropriate metrics) are not necessarily ticking the right boxes and are losing funding, while practices who are concentrating on the money, CQC box ticking etc are not always providing the best service.
    5 GPs that I have come across want to provide a better service, but they have been overwhelmed by the unfunded transfer of many secondary care activities, as well as increased expectation from patients who have very little idea of what happens in primary care.
    6 Extra funding is of very little use if there are no staff to buy (doctors, ANPs, nurses etc). Burnout and loss of workforce is a real danger
    7 The NHS is putting far too much funding into non clinical areas, and management is really ineffective.

    I think we need to agree what the function of GPs is going to be in the future. It is tempting to keep trying to provide what the public demand. Dr Cundy is right, we are not funded for that but we probably could be a central part of what is necessary. I personally would prefer to separate the "urgent care" from day to day General Practice with appropriate access to medical records. This would allow GPs to have ringfenced time to ensure that chronic disease for all ages is managed appropriately and that they are skilled up to do it! I am at the end of my career and will need this kind of care. I am worried that it might not be available

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