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Seven-day access costs 50% more than routine hours, warn government auditors

The Government has failed to consider the consequences and cost-effectiveness of its controversial drive to offer seven-day routine GP access, its own auditors have warned today. 

The National Audit Office’s Improving patient access to general practice repor t, released today, found that the cost of offering appointments in evenings and at weekends is 50% higher than during routine hours. 

It also warned that the data used by the Government when planning its workforce targets overestimated the number of full-time equivalent GPs in the system by 1,900, meaning that even achieving its recruitment targets will be not enough to provide seven-day access. 

The NAO said drives to boost GP numbers are at risk ‘from falling retention and increases in part-time working’ and added that ministers and NHS England need to address the ‘crude’ understanding of current demand and capacity.

GP leaders said that the report should be the impetus for ministers to ditch plans for seven-day routine GP services. 

Pulse has already reported that that at least £1.5bn will be ploughed into extending GP access by 2021, while NHS England’s own evaluation found that extending access to routine general practice across seven days had ‘no demonstrable impact’ on either emergency admissions or out-of-hours services.

The latest report targets the DH and NHS England for not fully evaluating the schemes. 

The NAO report said: ’The Department and NHS England have not fully considered the consequences and cost-effectiveness of their commitment to extend access.

‘They have used pilots to understand the demand for, and provision of, extended hours, and have used these to refine their expectations. However, they have not yet fully assessed the cost-effectiveness of the approach and overall resources that will be required.’

It added that the costs would be far higher than routine care.

It said: ‘If the additional funding is only used to meet the minimum additional capacity required by the new commitment, this would equate to £230 per appointment hour per 1,000 registered patients. In core contract hours the cost is an estimated £154’

The auditors also found that the Government’s target to recruit 5,000 GPs may not be enough due to ‘inaccuracies’ with its underlying data, highlighting that last year the NHS’s information centre – NHS Digital – overhauled its workforce modelling.

The original modelling had assumed qualified GPs under 35 worked shifts equivalent to 0.9 full-time GPs – eight sessions a week. However, the new model revealed that newly qualified GPs are equivalent to 0.77 of a full-time GP.

The NAO report said: ‘The latest available data on part-time working in new GPs suggest that there may be 1,900 fewer full-time equivalent GPs by 2020 than Health Education England had estimated there would be.’

GPC chair Dr Chaand Nagpaul said: ’Policymakers have underestimated the number of GPs required to deliver their promises by almost 2,000. This comes at a time when the NHS is already suffering from a chronic shortage of GPs with one in three practices having unfilled doctor vacancies.

‘Given that funding in general practice has failed to meet patient demand, NHS England and commissioners need to fully consider the consequences of their plans to extend access. To proceed without any sort of evaluation into the cost-effectiveness or the consequences of its objectives is irresponsible and could lead to much needed investment being spent on measures which don’t adequately meet patient needs.’

An NHS England spokesperson said: ’The NAO seem to be criticising the rather obvious fact that it inevitably costs more to provide evening and weekend urgent primary care services than it does during Monday-Friday, 9-5. The alternative would be that patients simply head to A&E, with all the consequences that brings for more major cases.

‘No one is suggesting each individual GP practice should offer this extended access, but there’s quite wide agreement that – as GP numbers expand – practices do need to club together to offer this service, a bit like the out-of-hours duty chemist rota. Across much of London, Manchester and a fifth of the country GPs are already doing this, and more areas will follow next year. The NAO are wrong to criticise the value for money of general practice, given that the per patient cost of a year of GP care is less than the cost of just two A&E visits.’

Julie Cooper, a Labour shadow health minister, said: ’It is really clear from this report that the Government has little understanding of the scale of the crisis in many of our GP surgeries. Access to GPs has never been worse, satisfaction levels are falling, patient safety is being compromised and morale amongst GPs and their staff is at an all-time low. 

’The Government’s plan to address this crisis is woefully inadequate and all depends on little more than its ability to introduce an additional 5,000 GPs and current recruitment and retention figures make even this unlikely.’