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GP winter access to be audited using ‘third next available appointment’

NHS England is set to collect ‘potentially misleading’ appointment data, GP leaders have said, as details of its new system to track access are unveiled.

Under the scheme to run through winter, practices will be asked when its ‘third next available routine appointment is’.

An email to practices from NHS England’s primary care team explains they will all receive a call in a bid to show ‘theoretically’ how long a patient would wait for an appointment, and to ‘quantify the pressure’ on practices.

NHS England said the call should take no more than four minutes, with practices told to brief receptionists to expect the first contact to be made in October.

Pulse reported earlier this month that NHS bosses were looking to collect appointment data to address a ‘lack of understanding’ around winter pressures.

But GP leaders said this method showed NHS England is out to ‘document disaster’.

And the BMA’s GP Committee warned this method takes no account of the variations in practice appointment systems that may prioritise telephone triage or emergency appointments and could produce ‘misleading’ results.

A letter to the profession from GPC workload management lead Dr Matt Mayer adds that it is ‘entirely voluntary’ but this is not mentioned in the letter from NHS England, seen by Pulse.

The letter circulated to practices in its Midlands and East region says: ‘NHS England has commissioned the North of England Commissioning Support Unit (CSU) to collect third next appointment data from each general practice in England.

‘The collection aims to better understand waiting times in general practice as well as quantify the pressure practice is under.

‘The data collected will give an indication of the amount of time in days a patient would theoretically need to have waited for an appointment at the time a booking was made.’

But Dr Mayer’s letter says: ‘GPC have expressed their deep concerns to NHS England regarding the potentially misleading or poor quality data this survey may produce, especially given the vast variability in appointment systems from practice to practice.’

He adds that there is a possibility emergency appointments or other modes of access ‘will not be accurately assessed’.

GPC is also concerned by the cost of such a survey ‘when general practice itself is collapsing due to chronic under-funding.’

Family Doctor Association chair Dr Peter Swinyard said: ‘I don’t know any practice that I talk to which has the availability which we would all like.

‘The amount of time used up on administrative stuff and on health surveillance, QOF chasing and so on is vastly more than it was and there is no way we can actually offer the service we want to. So they are just trying to document disaster.’

He also suggested figures may be ‘gamed’ because pressed practices would fear repercussions.

He said: ‘The bottom line is, if practices are honest and say “look, we’re stuffed, we haven’t got any appointments”, they will probably get a little visit from NHS England saying “why aren’t you complying with your contract?”

‘And so people will game the system and say the third available appointment is the next day.’

This week Pulse reported comments by RCGP chair Professor Helen Stokes-Lampard, who said practices were already ‘gaming’ access targets as they could ill-afford to lose the funding.

The college has previously said waiting times are a ‘risk to patient safety’ after a Pulse survey showed average waits remain at two weeks – despite efforts to boost access.

What does the GPC advise practices to do when they are contacted?

The GPC says GP practices are ‘under no obligation’ to respond to the survey, but adds that for those who ‘wish to do so’, it advises:

  • Direct the call to the practice manager or another suitable manager. If no such person is immediately available, then take a return contact number and instruct the caller that someone will call them back later;
  • The person giving the data should tell the caller when the third next available routine appointment with a doctor is;
  • Appointments which can be booked into a locality hub are valid for the purposes of this survey, and the third next available routine appointment should be given;
  • If no such routine appointment exists due to the design of your appointment system (eg: total triage, on-the-day, nurse triage etc) then inform the caller you are unable to answer the question, and explain the reason for this.