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One fifth of GP appointments avoidable, finds NHS England audit

A fifth of GP appointments are potentially avoidable, according to an audit funded by NHS England.

The audit tool, developed by the Primary Care Foundation, has been used by more than a thousand GPs in nearly 350 practices since it was first launched in 2015.

The data collected as of May 2018, revealed that 20.5% of GP appointments could be avoided, with the most common reason being that another clinician in the practice could have seen the patient.

But this is lower than the 27% figure NHS England quoted in the GP Forward View after a very small early pilot of the audit took place in 2015.

Henry Clay, director of the Primary Care Foundation, told Pulse that the latest figure reflects a broader range of GP opinion about what is an avoidable appointment.

He said: ‘What the clinicians do is at the end of each consultation, for the period they’re using the tool, they categorise the appointment broadly into whether it was potentially avoidable or not.

‘But particularly for those are potentially avoidable, how it might have been dealt with differently. Clearly there’s a degree of subjectivity in doing that.’

The initial audit of 56 GPs between January and June 2015 for NHS Alliance’s Making time in general practice report found that 27% of appointments could have been avoided.

But Mr Clay said: ‘We may have slightly, in picking people who are willing to answer when we were doing the making time survey, have got enthusiasts rather than anything else.’ 

He added that those who have taken the audit since ‘are probably being a bit more careful about the framework in which they’re working now … and maybe setting some bounds on the scope that may not have been done by early people’.

Following the intial audit, NHS England funded the Primary Care Foundation to roll it out more widely in the past six months, but Mr Clay was unable to disclose how much had been spent on the tool.

The audit found that of the avoidable appointments 7.5% could have been seen by another clinician in the practice, 4.1% could have been met by another local service, while another 4.1% ‘should not arise if system works’.

But Mr Clay cautioned that not all 20% ‘could or would be avoided in a future world’.

He said: ‘We all know there are plenty of cases where patients may come to a GPs three or four times before he or she starts to pay attention to the fact that the GP says actually, you really should see the nurse about this.

‘It takes time for people to behave differently and you’re never going to catch everyone in advance.’

However, he said the data provide ‘information for a discussion within the practice as to what they might do differently, whether that’s their internal, operational and clinical processes or whether it’s about collecting information to suggest to the CCG’ new ways of working.

Dr Arvind Madan, director of primary care at NHS England said: ‘We are already working with practices and other stakeholder partners to expand the ways in which practices can work differently to manage workload. Having this data will help stimulate local conversations within practices further and encourage engagement in the Time for Care programme.’