GP access ‘should be judged on wider range of measures’, say experts

By Lilian Anekwe

The Government has been urged to adopt a wider definition of access to GPs, including whether practices provide email consultations or are accessible by public transport, in a new report from the King's Fund published today.

The authors of the latest report to be published as part of the influential think-tank's inquiry into general practice criticised the ‘one size fits all' approach to access.

As exclusively revealed by Pulse in May, their review rejects the previous measures of access - which it says were not developed in a ‘systematic' way - and proposes 23 new measures of general practice access.

The report will feed into recommendations made to the Government by the Inquiry's overarching panel. The Government has already announced it will abandon targets of no ‘clinical value', including targets for 48-hour access and extended hours.

The report proposes several new measures, including whether the practice is accessible to people by walking or public transport and to people with disabilities, whether adequate car parking is available and whether patients can book appointments online and email their GP.

‘Most of the measures of access that are currently available have not been developed in a systematic way through consideration of an overall framework for access. Moreover, often one policy measure may stand in contradiction to another', the report states.

It also criticises the current measure of access, including the (now scrapped) GP patient survey, and calls for a rethink of how general practice access is measured.

‘Surveys are needed that does not just measure access in a broad sense, but that focus on establishing trade-offs between the different aspects of access. These could be administered alongside discrete choice experiments, to provide some notion of how patients value the different attributes of access to care.'

A survey of GPs and patients conducted as part of the inquiry found over half of respondents suggested that, in comparison to other issues, access was the lowest priority for future improvement, and more than half reported that continuity of patient care should be the highest priority.

The researchers' review the literature on measures of access used both in the UK and internationally, and suggested 23 measures to create ‘a framework for measuring access that attempts to pull all elements together' (see box).

A second report published today, and also commissioned as part of the King's Fund Inquiry, examined the literature on the quality of patient involvement and engagement in primary care.

The researchers from the Picker Institute Europe found that while there are many tools to assess and monitor patient engagement in general practice consultations, there are few reliable and robust studies of patient involvement in developing primary care services.

1 GPs per 100,000 population by PCT
2 List size per GP
3 Percentage of population within 15 minutes of a surgery by walking or public transport
4 Percentage of population without a car within 15 minutes of a surgery by walking or public transport
5 Compliance with the 1995 Disability Discrimination Act
6 Proportion of people very or fairly satisfied with practice environment and facilities
7 Proportion of people who found it very or fairly easy to get through on the telephone to GP surgeries, by surgery
8 Proportion of people who found it very or fairly easy to speak to their GP on the telephone, by surgery
9 Can patients book appointments online?
10 Can patients communicate directly with GP or practice staff via email?
11 Home visit requests refused by GP, as a percentage of all consultations
12 Proportion of people able to get an appointment with a GP within 48 hours
13 Proportion of people able to book at appointment more than two days ahead
14 Proportion of people satisfied with surgery opening hours
15 Proportion of people who felt that care from out-of-hours GP services took too long
16 Proportion of people who felt that care from out-of-hours GP services was good or very good
17 Proportion of people who state that they wait a bit or far too long in surgery
18 Proportion of people able to see a GP fairly quickly
19 Does practice have or make use of the Electronic Prescription Service?
20 Maximum of 48 hours from patient request for a prescription to availability for collection by the patient
21 Is the practice open or closed to new registrations?
22 Proportion of patients who said they had been able to see the GP of their choice

Source: The King's Fund 2010