‘Blanket’ GP access policies take staff away from more effective work, study finds

Government-imposed policies on online GP access and the effort needed to keep systems working are taking staff away from work that would be ‘more effective’, according to new research.

A study led by the Universities of Oxford and Southampton argued that ‘widescale policies’ on access including keeping online consultation tools open during core hours are creating more work for GP staff and challenging what practices are able to do.  

‘Persistent tinkering’ with access systems has made it difficult for patients to understand how to get an appointment, especially if they visited their practice infrequently, the study found.

The research, published in the British Journal of General Practice, said that policymakers should understand that when patients seek to make an appointment with their GP ‘they may struggle with the expectation that they can use digital tools’ or will be ‘happy to see a care provider who is not their GP’.

The researchers said that ‘blanket policies’ including the October online access changes are taking practice staff ‘away from doing other things that may be more pressing or effective’.

A better approach would be to allow individual general practices to do what works for their population, the researchers said.

They conducted a comparative case study in eight English practices, and sought to represent areas of high deprivation, and rural and urban areas, as well as different practice sizes. 

The study concluded: ‘There is a clear argument for allowing general practices the resources, time, and space to adapt access arrangements for their populations.

‘Single-access solutions tried in previous research and favoured by politicians and high-level policymakers have not “stuck” or solved the access problem.’

The researchers also raised the question about whether access to GP appointments should be focused ‘so exclusively on the management of demand’.

They said that this focus has delivered systems that require ‘constant adaptation’, provoke dissatisfaction and has encouraged practices and policymakers to ‘continually seek new initiatives’ that will improve access.

They added: ‘Without better resourcing (notably to address the shortfall in numbers of GPs) practices will be obliged to continue expending effort and resources on tinkering or adapting access systems.

‘An alternative approach would be to support general practice in applying flexibility to their management of access rather than using top-down approaches to standardise access, and to support patients to help them better navigate the layers of access they encounter.’

Study co-lead Helen Atherton, professor of primary care research at the University of Southampton, said that practices are ‘constantly tinkering and amending’ their access systems to try to make them work for their patients and that they should be supported to do that.

She added: ‘At the moment, systems are managed top-down from the Government. But that does not necessarily take account of what people want and need. A better approach would be to allow individual general practices to do what works for their population.

‘There are a lot of blanket policies, such as the policy implemented in October that instructs all GP practices to offer online consultations from 8.30am to 6pm.

‘But that takes practice staff away from doing other things that may be more pressing or effective. Everything that is put in place to improve access is actually creating more work and challenging what practices are able to do.’

Pulse has contacted the Department of Health and Social Care for comment.

The BMA is currently in formal dispute with the Government over the online consultation requirements.

Since 1 October, GPs are contractually required to keep online systems open for patient requests between 8am and 6.30pm for routine enquiries regardless of capacity – but the GPCE has previously warned that GPs would struggle to implement the requirements safely.

A Pulse white paper and investigation last year exposed a widening gap between how access is discussed in policy circles vs. how it is actually experienced in practices.