Here is why booking a GP appointment is harder than ordering a takeaway

Pulse editor-in-chief Jaimie Kaffash reflects on the publication of our report about general practice access, and the health secretary’s desire for GP appointments to be as easy as ordering a takeaway

I have just spent most waking hours of the past six weeks on our report about general practice access, which aimed to provide a voice often missing in the debate – that of GPs and their staff. The very last piece of writing I was going to do before going on holiday was this editorial on the report. There is so much to say – I wrote 45,000 words on GP access, and it could easily have been four times as long. Distilling this into 600 words felt like a monumental task.

So thank you Wes Streeting for your comments at the Labour Party conference, in which you asked ‘why shouldn’t booking a GP appointment be as easy as booking a delivery, a taxi or a takeaway?’, and then accused the BMA of trying to ‘turn the NHS into a museum of 20th century healthcare’. Because answering this question is relatively easy when you have been dreaming of Excel spreadsheets and conversations with practice managers. So let me give you a non-exhaustive list of why booking a GP appointment is not the same as ordering a takeaway.

Takeaway shops have control over demand: GP practices, on the other hand, do not. There is unlimited demand for GP services, and they cannot switch it off. And any control they did have over demand has been taken away today. No longer can they close online access for the safety of their patients. I spoke to dozens of practices who had access processes that were specifically designed for their own patients, based on what their patients needed. They have had to ditch these processes in order to spread themselves more thinly, ultimately to the detriment of patient care.

Takeaway shops set their own pricing: GP practices, on the other hand, are funded through an out-of-date formula, that they have to abide by. This formula is based on 25-year-old data, and discriminates against practices in deprived areas. Our report showed that there were strong links between how much funding a practice received and the level of access that they could provide. For all the talk about ‘coasting’ and ‘laggards’, the level of access is very much linked to factors outside of a practice’s control. Unlike KFC, they can’t raise their prices to invest back into the business (and certainly not to increase their profits). Also, takeaways get paid by activity (per takeaway); GPs don’t (largely); they are paid the same whether we see 10 patients or a 100. GPs are trying to sell quality, not quantity.

Takeaway shops aren’t feeling pressure from government authorities, the media, and their customers to produce more with the same resources: GP practices, on the other hand, are expected to deliver on a range of moving targets. At various points in time, practices have been accused of too long waiting times, too few appointments, not enough GP appointments, not enough face-to-face appointments, not enough online appointments. All general practice data is in the public domain, allowing the media to publish context-free information naming and shaming the ‘worst performing’ practices.

The quality of a takeaway shop is easy to measure: the quality of a GP practice, on the other hand, isn’t. Appointment numbers are easy to measure. To an extent, so is waiting times – though there are caveats. The same is true for patient satisfaction. But the quality of care provided is hard to measure. This is most obvious when looking at continuity of care. It has been found in countless studies to provide numerous health benefits. But continuity and access are often contradictory to one another. A practice can reduce waiting times by booking the patient in with the next available healthcare professional rather than the GP who knows them well. This isn’t an abstract concept – numerous government initiatives, such as extended hours and the additional roles reimbursement scheme, actively reduces continuity in favour of access.

Takeaway shops are easy to contact because they have the staff they need: GP practices, on the other hand, do not. It is likely that Mr Streeting was referring solely to the ease of contacting practices and booking an appointment when he made the comparison. But it is impossible to separate the logistical aspects of access with the availability of appointments and quality of care provided. The vast majority of practices that currently switch off access or stop taking calls aren’t doing so because they have reached some arbitrary limit. They do so because either their systems are designed in the best interests of their patients, so as not to spread themselves too thin – to use Mr Streeting’s own analogy, you don’t find too many kebab shops open at 8am.

Or, more importantly, they do so because they can’t safely assess all the requests they receive. One GP gave the example of ‘a mother asking about a 15-day-old baby with a sticky eye – buried in this was a comment that her baby was making grunting sounds with her breathing’. As the BMA has pointed out, there needs to be safeguards around this implementation. Or, as a commenter on our news story put it: ‘Barring anaphylaxis, getting the order wrong on a Dominos won’t result in physical harm to the customer.’

Two of the main conclusions from the report addressed the need for a change in attitude from ministers. First, policymakers’ obsession with access has to change. There needs to be a focus on quality of care provided, without a blame culture. Second, and related, policymakers need to start trusting GP practices.

These are anathema to politicians. Quality can’t be measured so easily, blaming individual practices is much more attractive than providing a health system – and society – that is conducive to good care, and there is the constant danger of headlines around the Government caving in to the demand of lazy and greedy GPs. But if they are genuine about providing better care, they will give GP practices the flexibility they need to provide it. These are takeaways Mr Streeting should be paying attention to.

Jaimie Kaffash is editor-in-chief of Pulse

You can find all the data and the methodology in the full report. Click here to download the full report. GPs can download it for free.

Commercial partner of this white paper: General Practice Solutions