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NationalAuditOfficeDecember 2 2015

A National Audit Office report has highlighted “considerable variation” between different patient groups and their access to general practice.

Older patients were more likely than younger patients to report that they were able to access appointments, while people from a white ethnic background reported better access than those from other ethnic groups. A fifth of patients reported opening hours were not convenient, said the NAO.

“Differences in GP practices’ working arrangements also affect the proportion of patients who can get appointments. Nationally, 92% of people live within 2 kilometres of a GP surgery, but there are stark differences between urban and rural areas. Only 1% of people in urban areas do not have a GP surgery within 2 kilometres, compared with 37% in rural areas.”

In addition, “deprived areas tend to have a lower ratio of GPs and nurses to patients, and where the ratio is lower it is harder for patients to get appointments.”

The NAO made the comments publishing its review of patient expectations and experience of access to general practice, as well as demand for general practice and its capacity. Its report, ‘Stocktake of access to general practice in England’, found that while “people’s experience of accessing general practice remains positive, with almost 9 in 10 patients reporting in 2014-15 that they could get an appointment,” patient satisfaction with access is “gradually and consistently declining”.

Problems with GP recruitment and retention are highlighted, “with 12% of training places in 2014-15 remaining unfilled. GPs make up only 29% of the general practice workforce, so alone are unlikely to be able to deal with the rising demand for services. Practices are increasingly using other staff to help manage demand,” said the NAO.

“The distribution of general practice staff across the country does not reflect need. NHS England allocates funding to local areas using weighted populations that reflect factors such as demographics, health needs and local costs. Despite this, inequalities remain, with the combined number of GPs and nurses in each local area ranging from 63 to 114 per 100,000 weighted population.”

Katherine Murphy, Chief Executive of the Patients’ Association, said: the NAO report “only confirms what we hear from patients regularly on our National Helpline. Patients do not have good enough access to primary healthcare.

“The report highlights how for many younger patients, GP opening times are inconvenient. We need an NHS that understands that people have jobs and families to take care of. Much more must be done to ensure that they have access to GPs, particularly in the evenings and at the weekend.

“The variation in care highlighted in this report is unacceptable for patients. A patient living in a deprived area should have the same access to their GP as anybody else. Funding and support needs to reflect the population, demographic and local costs of an area.”

Ms Murphy said the Patients’ Association “continues to support the Government’s plan to implement a truly seven-day service,” but called for funding and support for primary care that will protect patient safety in the long term.

Dr Maureen Baker, RCGP Chair, commented that as general practice “strives to meet the increasing demand of a growing and ageing population, with consistently fewer resources, our patients’ ability to make a timely appointment is worsening.” Recent analysis of the latest GP Patient Survey suggests that on 67 million occasions this year, patients will wait more than a week for an appointment with their GP or nurse.

“This is most worrying because when a patient can’t make an appointment with their GP, we don’t know where they go; they might get better on their own; they might visit A&E where care is far more expensive; or they may simply stay sick,” she said.

Links:

NAO announcement

NAO ‘Stocktake of access to general practice in England’

Patients’ Association response

RCGP response

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