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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.’