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If NHS England was serious about patient access…


GP support package Pulse editorial


Our exclusive this morning, which revealed that the data used to identify the 20% ‘worst performing’ practices was based on a single month, shows up how pointless and unfair NHS England’s and the Government’s access plans really are. 

Let’s for a moment take NHS England at its word and say that it really believes that access to some GP practices is affecting patient care. Does it look like they are serious about improving access to benefit patient care? Absolutely not.

First, they wouldn’t target a percentage of practices in every region. It is completely arbitrary to believe that patient care is being affected in 20% of practices in a region. What if that region had a high overall level of access? Or, to expand that, what if England has a generally high level of access?

If NHS England was serious, they would have specified the levels of access that practices should be providing, which – as horrific as it would be – at least has some rationale, and would give practices something to aim for. Along the same lines, their actual strategy leads to perpetual ‘underperformance’ – there will always be a bottom 20%, however you define this.

Second, if they were serious, they would scrap the idea of publishing practice-by-practice level data on access. The health secretary claims these are not ‘league tables’, but this is semantics. Any regional newspaper editor worth their salt would publish this data as a league table as soon as it is released, gleefully proclaiming the best and worst practices on its patch. This won’t help improve patient care, it’ll just shame those who are struggling most, usually through no fault of their own, or simply reflecting the wishes of their patients.’

And finally, if the NHS was serious about access, they would use robust data, looking at trends stretching back months and years. Yet, as our exclusive today revealed, they are doing nothing of the sort. They are looking at a single month of experimental data, and August no less, a month that is most likely to be an outlier due to falling completely in the school holidays. This data will tell you nothing.

I still believe that the case linking access – either face to face or general availability of appointments – to patient outcomes hasn’t been made, and certainly not when accounting for factors such as demography or deprivation.

But even if someone was to establish a link, this strategy would do nothing to address it.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk

READERS' COMMENTS [5]

Stephen Fowler 10 November, 2021 4:09 pm

I still believe that the case linking access – either face to face or general availability of appointments – to patient outcomes hasn’t been made, and certainly not when accounting for factors such as demography or deprivation.

None of the data that is collected through NHSE, or even our appraisal system, is linked to or focused on patient outcomes – it’s all about satisfaction rates, which by definition will never get to 100% (or even close) and are not what a publicly funded health service should be focussed on

Vinci Ho 11 November, 2021 9:33 am

The way this is being unfolded cannot prevent one from criticising the style and culture of NHS/I administration:
(1) Pure laziness in terms of dragging very short term data , as a response to political demands from the hierarchy . As I wrote before , this is a knee jerk response to populism demanding to scourge GPs severely.
(2) Incompetent in terms of not even knowing where to start looking . This is actually a reflection how the prime minister and his government exercises governance . While I would give some credits to the Chancellor, the rest of government is passively reactive with zero medium to long term vision . The number of U-turns are egregiously ridiculous and clearly overshadowing the majority of 80 seats in House of Commons .
(3) Malevolent in terms of being evidently against GPs despite the classical British hypocrisy stating the vital roles played by GPs in NHS . Remember , tomorrow is the deadline for GP earnings declaration. The timing cannot be ‘better’ in terms of game theory to hit your enemy at the best opportunity.
Amanda Pritchard , where are you hiding ?

Angus Murray-Brown 12 November, 2021 1:43 pm

The big problem with actually defining access levels is the risk that lots of practices that provide more access would then reduce it towards the stipulated amount.

Patrufini Duffy 12 November, 2021 10:18 pm

All the professions with least accessibility, gain the greatest perverse respect. Lawyers, celebrities, dentists, solicitors, accountants, and I dare say it bankers. Because there is value placed on their head and “worth”. Wake up.

John Evans 17 November, 2021 1:17 pm

Independent contractor status has been a burden and harmed GPs.

GPs are expected to meet demand. That demand has been fuelled by the government and media for years. Increasing unfunded work.
“You can never be too safe” culture pervades (which is actually untrue = seeking advice for trivial symptoms takes time from more critical activity).

The pandemic enforced change on primary care to control disease spread and to protect the vulnerable whilst still attempting to preserve a baseline primary care capability.

Even more so, as the public expects things to simply switch back on, the demand clearly exceeds capacity and instead of allowing the professionals to manage the tsunami there is endless government and media interference that risks destabilising things further.

I really cannot see why the profession has not simply agreed to provide specific activity in return for set remuneration citing minimum standards just as the rail or air industry demand. The professional bodies such as the colleges and GMC have long been prepared to sacrifice clinicians whose performance may have been impaired due to unsafe working conditions eg under resourced paediatric departments.
They even mandate the minimum clinical activity to maintain currency.

Yet they have been disgracefully silent regarding the safe limit for clinical contacts or provide advice or support to clinicians working in such conditions. It has been a disgrace that has been tolerated, and even enabled by some colleagues, for far too long.