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An excess of access

An excess of access

GPs cannot bend space-time to create new appointments, says Dr Copperfield

As a declaration of war against her GP, who happened to be me, it was really quite impressive. She came in clutching, in one hand, the Daily Mail, and in the other, a complaint form. ‘Nice to see a GP face to face at last, do you know how long I’ve waited for this appointment?’ she said, with a look that combined the sneer of someone convinced I’ve had my feet up for the past couple of years and the indignation of the stoic who has endured her pain for as long as is humanly reasonable.

And, to be fair, it was a nasty ingrowing toenail.

But the case did highlight that the finger of blame for GP access issues remains pointed in completely the wrong direction. And no wonder. We already have the glorious QOF ‘quality improvement’ domain of ‘Optimising Access to General Practice’, in which, to Optimise Access to 37 QOF points, we have to ‘demonstrate continuous quality improvement’ on improving access and participate in ‘network activity to regularly share and discuss learning… on optimising access’. Which we’ll all make up on the basis that,  a) no one ever actually reads the feedback templates and, b) the time could be better spent, ironically, seeing patients.

Then there’s the recently introduced publication of league tables on GP waiting times and F2F appointments. This, of course, is all about transparency and opportunities to improve and not at all about keeping editors well stocked with anti-GP headline fodder and providing patients with the rage to kick us in the nuts.

And, finally, we now have NHS England’s attempts to modify our five-year contract by incorporating a new QOF ‘access marker’ and an IIF ‘Capacity and Support Indicator’ to include a target for appointments within two weeks.

Which suggests that, in the same way the folks at NHSE don’t seem to get the concept of ‘fixed’ in ‘fixed contract’, they don’t seem to understand the concept of ‘laws’ in ‘laws of physics’. 

We GPs cannot bend space-time to create new appointments but as long as NHSE continues to churn out these initiatives to suggest we can, everyone – hospitals, patients, media – will be misled into thinking that access failure is our fault. 

And that’s without addressing the other obvious issue of the NHS generally falling to bits with the result that even if we could solve GP access, there would be little benefit for the 10% of patients needing onward referral – they would simply swap a primary care bottleneck for a secondary care one.

Look, NHSE, the issues around access are not related to our laziness, lack of motivation, stupidity, reluctance to innovate, inability to ‘work smartly’ or ‘at scale’ etc etc, so they will not be solved by the addition of spurious new domains or indicators, or by publishing league tables. The problems are caused by – and I can hardly stop myself yawning as I write this – a lack of clinicians and too much work. 

So please stop thinking up these moronic initiatives/inducements/quasi solutions that imply general practice is to blame.

If you do continue to insist this is a problem I can solve, then I may have to innovate, discuss and disseminate with the PCN my radical idea for a new pre-appointment online questionnaire for patients, to screen out unnecessary consultations. 

And the first question it asks will be, ‘What newspaper do you read?’

Dr Copperfield is a GP in Essex. Read more of his blogs here



Please note, only GPs are permitted to add comments to articles

Truth Finder 14 March, 2023 3:28 pm

Well said. Moronic access targets from dream land. Even a customer paying to eat at a restaurant cannot have unlimited instantaneous access and unlimited food. Not doable.

Mona Vaidya 14 March, 2023 6:52 pm

Well said! Hopefully NHSE is reading this

David Church 15 March, 2023 8:05 am

Can NHSE read then? I thought they just did ‘copy-and-paste’ from the Daily Mail.

Malcolm Kendrick 15 March, 2023 4:42 pm

Dear NHSE. You can have any two out of three: immediate access, cheap, high quality.

Your choice.

Dr No 20 March, 2023 3:13 pm

Managerialist government stooges.

Carpe Vinum 21 March, 2023 11:47 am

This is the dichotomy; the NHS is broken almost beyond repair by a government that one of a more cynical bent would say are purposefully running the NHS down for Machiavellian intents, and yet the broader press and therefore public opinion is that we in General Practice are to blame. Which sits in stark contrast to the “angels” that are nurses doing their best under difficult circumstances, or even those super clever hospital consultants who, whilst not being quite as messianic as the angel nurses, are still perceived to be several echelons above us. Which is not hard given that the average GP seems to be, as far as the press is concerned, somewhere between pond scum and cockroaches in the pantheon of respect and likeability

Finola ONeill 24 March, 2023 1:17 pm

I should say that GPs stand between the government privatising the NHS and accessing the NHS data the govt have promised to all those Big Pharma, med tech, google deep mind, genome tech (Illumina/Grail; rishi sunak visited dec 2021; cameron is adviser to; patients recruited via NHSx access to patient info; I call that cold calling) etc
AGPs as independent contractor; they can neither control us or the data.
They are very angry and this is an orchestrated campaign by the right wing press and the govt. It ain’t random.
Hang on in peeps, take comfort in the fact that you are really pissing them off


New Bill passing Parliament;
They are not too keen on consent either. Gets in the way of “progress”, ie product dev ie profit.
They want to link up GP records; phenotype with genetic research; genotype.
First GPDPR 2021, now GP records uploading Nov 2022. 2 attempts by NHSE to gain control of data. Now they want retrospective as well as prospective.
Patients can sign up if they want their bloody access. Automatic uploading is unnecessary and unlawful. They bloody know it.
They got 30 million people signed to the NHS App for Covid for holidays, etc. And the govt have spotted an opportunity.
Screw consent. Screw patient risks. They acknowledge risk of severe patient harm for automatic uploading for patients in coercive relationships, etc.
The govt have been blocked twice in data grabs. Sure as shit they ain’t happy with GPs.
The ICR paper mentions GP surgeries doing genetic tests for this research. No matter that none of these tests have any proven benefit and may have some pretty awful consequences for people. Disease or predisposition to without treatment? Great to know you will get x or y or very likely to, but no rx.

And GPs do 90% of NHS consult so the govt can’t do healthcare without us. And through the independent contractor status they can not control us or privatise us to some big company. Or control our data, by far the most valuable NHS data.
The vitriol comes from a place of power. Ours.
Keep going little peeps and watch them sweat.

Merlin Wyltt 26 March, 2023 9:28 am

Shock, denial, anger, bargaining, depression—-I’m working my way through the 7 stages.

We could change the GP contract to a model where we can pad for each patient that we consult

That would solve the GP waiting list overnight