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Major study casts doubt on benefits of extended access drive



Improving GP access in hours is more effective than extended hours access in relieving pressure on out-of-hours services, a major research study has concluded.

The study, based on data from 570,000 patients, found that continuity of care was the biggest factor in reducing demand on out-of-hours services, followed by increasing the emergency appointments available to patients with 48 hours.

The results challenge the Government’s strategy on increasing extended hours access following the recent expansion of the prime minister’s flagship pilot scheme, but seem to support moves by Labour to introduce a 48-hour target for appointments.

However, GP leaders said that although improving access in-hours would be beneficial, this is not possible within the current funding constraints.

Using a sample population of over 567,049 patients from the 2011/12 Patient Survey, the researchers concluded that patients who ‘never or almost never’ see their preferred GP are 1.26 times more likely to use out of hours services than that those who ‘always or almost always’ see their preferred GP.

The research also shows that enabling patients to both book ahead and access emergency appointments within 48 hours would reduce the use of out-of-hours services by a potential 11%, from 7.47% of patients down to 6.67%.

Patients who say they generally cannot get appointments are 1.21 times more likely to use out hours services than that those who can.

The report, published in the Emergency Medicine Journal, said: ‘It is commonly believed that some patients are unable to attend for routine or urgent issues during usual surgery opening hours due to daytime commitments, particularly full-time employment… However, contrary to expectations, our study found that the association between out-of-hours use and convenience of opening hours was in fact stronger among those in part-time work and those not in work or education.’

‘Assuming that the observed association between in-hours access and out-of-hours primary care use is causal, we estimate that there would be an 11% relative reduction in the proportion of patients who use out-of-hours primary care if it were possible to achieve optimal experience of access to in-hours primary care for all patients.’

Lead researcher Dr Yin Zhou, a trainee GP and academic clinical fellow in general practice at the University of Cambridge, said: ‘The Government is keen on extending opening hours, but it is ignoring other access factors. A lot of factors can be improved during standard opening hours – such as seeing a preferred GP and even getting through on the phone. We should be focusing on these as a package, rather than one individual thing such as extending opening hours.’

The study comes as the Labour Party last week announced that it wants to invest £100m in increasing the availability of GP appointments to patients by bringing back a revised version of the 48-hour target it had in place when it was last in Government.

Called the ‘access guarantee’, the policy differs from the target in that it will also focus on same-day access and ability to book ahead. They also promised, via an opinion piece in Pulse, to ensure there is enough GPs to make the access guarantee a reality.

But GPC negotiator Dr Beth McCarron-Nash said neither the Government’s access scheme nor the Labour proposals would improve patient care.

She said: ‘I would support the drive to improve access in-hours but this constant drive to push GPs to spread themselves ever thinner will not improve the quality of services. I welcome this study, because it is something that the GPC has been pushing for for some time.’

‘I think general prctice is at a crossroads and whoever is elected needs to be perfectly clear that they are not going to be able to deliver the general practice we have been delivering unless there is a substantial increase in the number of GPs and increase in funding into practices to help them deliver it, because of the explosion in demand and workload that we have seen.’

Dr McCarron-Nash went on to brand the Labour Party proposal as ‘madness’ and a ‘public soundbite’.

She said: ‘It is short-sighted, non-evidence based policies, which sound great – public soundbites – but the reality is we need sustained investment in core general practice so that practices can actually plan, employ the necessary staff and actually invest in their practices to be able to deliver a quality service to patients.’

Read the full paper here.