Major Pulse report on GP access calls for change in ministers’ attitudes

A major report by Pulse and its publisher Cogora is calling for ministers to prioritise GP continuity of care over access, to strengthen the partnership model and to revamp contract funding.

The report, Access All Areas, is being launched at a fringe event of the Labour Party Conference in Liverpool today, and is based on a survey of 2,000 general practice staff, interviews with more than 100 and an analysis of more that 25 data sets on each practice in England.

It reveals that practice staff are facing more pressure and complaints around access since Covid, that initiatives such as extended hours have had negative effects of the quality of care and that appointment numbers are going up while patient satisfaction is going down.

The report also reveals that the level of access offered by practices is linked strongly to their funding, patient demographics and deprivation levels.

The main findings include:

• 70% of general practice staff say complaints have risen since the Covid pandemic;
• 31% of patient complaints to GP practices relate to access;
• 55% of practice staff have faced verbal abuse due to access issues, including 71% of practice managers;
• 41% said they would need to reduce their patient list size in order to provide the level of access they would like;
• Almost half of GPs and practice managers see continuity of care as being a bigger priority than waiting times, ease of contacting the practice, offering face-to-face and on-the-day appointments

This comes as the BMA GP Committee England is threatening to enter dispute around contractual requirements  being implemented from Wednesday, 1 October that will enable patients to make unlimited urgent and non-urgent online consultation requests from 8am to 6.30pm, Monday to Friday.

A number of GPs and staff featured in the report made reference to these changes, and warned that they would have to reduce the quality of care to implement these new requirements.

The Access All Areas report calls for a complete reconfiguration of policy on general practice access, including:

• Urgent reform of the Carr Hill funding formula to reflect deprivation.
• Centralised staff funding, freeing government to invest without fear of ‘GP pay’ headlines.
• Strengthening the GP partnership model by reducing personal risk and encouraging more GPs into leadership.
• Ensuring GP practices remain GP-led, preventing hospital trusts from taking over routine care via neighbourhood health centres.
• Investment to modernise small practices, which deliver higher satisfaction and continuity.
• Consolidating funding into simple capitation payments with ringfenced staff costs.
• Shifting the debate from ‘more appointments’ to better care, built on continuity.

Report author and Pulse editor in chief Jaimie Kaffash says: ‘Our research shows that high-performing practices don’t succeed by chasing appointment numbers – they succeed by focusing on continuity, quality, and what their patients actually need. If government really wants to improve GP access, it must trust practices, fund them fairly, and stop reducing general practice to a numbers game.

‘Comments around GPs “coasting” or being “laggards”, as the health secretary has said this year, fails to acknowledge that there are systemic reasons why some patients are receiving better access than others, and it is linked to funding, recruitment, patient demographics and size of the practice.’

Dr Amanda Doyle, NHS England’s national director for primary, said: “Pulse is wrong to say patient satisfaction is falling – the GP Patient Survey results actually show that satisfaction has increased by 1.5 per cent and a record 74% of people report it was easy to contact their practice compared to 61% last year according to the ONS. 

‘The NHS is not complacent, and we know there is more work to be done, and with the recent recruitment of more than 2,340 GPs we are hopeful that we can improve access for patients further. 

‘We are also working hard alongside staff, partners and the government to prevent abuse and ensure all GP staff are able to work in a safe environment and be treated with dignity and respect – it is completely unacceptable for staff to be harassed or abused while they’re trying to do their best for patients.” 

The report is being launched during the Labour Party Conference at an event, in conjunction with Rebuild General Practice, this morning. It will involve a panel discussion with Jaimie Kaffash, GPC England deputy chair Dr Samira Anane, GP and Stroud MP Dr Simon Opher, Londonwide LMCs CEO Dr Lisa Harrod-Rothwell and Re:State research manager and head of health Rosie Beacon.

You can find all the data and the methodology in the full report. Click here to download the full report. GPs can download it for free.

Commercial partner of this white paper: General Practice Solutions