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waitingroomNovember 4 2015

A review of the pilot projects extending GP surgery hours has found that “patient demand for routine appointments on Sundays has been very low.”

Collectively, the pilots have been considered successful at providing additional appointment GP time and more hours for patients to access other clinicians. While weekday slots have been well utilised, “understanding the pattern of demand locally is important in order to provide the most relevant and value for money service for patients,” says the report.

“The size of the local health economy, maturity of partner relationships, geographic profile and transport infrastructure are all key factors. An urban solution may not be appropriate for a rural local health economy for example. For any localities seeking to replicate wave one pilot models it will be critical to ensure that initiatives are locally tailored, bearing in mind these contextual factors.”

The findings come in the review of the initial phase of the Prime Minister’s Challenge Fund schemes around improving access to general practice. It says that around “41-51 total extended hours per week are required per 100,000 registered population in order to meet the levels of demand experienced in these pilots; of these 30-37 hours should be GP hours.”

It also notes that telephone-based GP consulting models have proved popular and successful, and there is growing evidence to suggest this could be cost effective. However, video or e-consultations have yet to show significant benefits and have had low patient uptake.

It also notes that joint working with other health professionals, including advanced nurse practitioners, pharmacists, the voluntary sector, care homes, physiotherapists and paramedics has released local GP capacity as well as better matching patient needs with practitioners.

Dr Chaand Nagpaul, BMA GP committee chair, said the independent evaluation “raises serious concerns about the value and expense of the government’s inflexible approach to seven day services for general practice.

“There was extremely poor demand from patients for appointments on Sundays, and in many cases on Saturday afternoons, resulting in precious NHS resources being wasted on keeping near empty practices open and staffed. The cost of providing care during these hours was significantly higher than routine GP practice appointments during the week.

“While some areas showed a slight decrease in minor illness attendances at A&E, there was no reduction in hospital admissions, and any cost saving would need to be balanced by the considerable expense of running these pilots.”

Dr Maureen Baker, RCGP Chair, said: “It will come as no surprise to dedicated and hardworking GPs that schemes to extend access have not been as popular as the Government predicted. It might sound like a good idea in principle, but our patients realise that this isn’t the best use of precious NHS funds – and they have better things to do on a Sunday afternoon than have their ears syringed.

“The Prime Minister’s GP Access Fund has provided welcome funding to some GP practices - but family doctors must be free to tailor these resources to the needs of their local populations, in the best interests of their patients.”

She said she hoped the evaluation would “spur the government away from its obsession with a seven-day service and towards ensuring that our existing routine family doctor service and GP out of hours services are more integrated and robust, so that our patients can see a GP when they really need one.”

Links:

NHS England announcement

NHS England PM’s GP access Fund Wave One National Evaluation

‘Prime Minister’s Challenge Fund: Improving Access to General Practice First Evaluation Report: October 2015’ report by Mott MacDonald

BMA comment

RCGP comment

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