GP access report shows plans for seven-day service 'in disarray'

The government has failed to consider fully the consequences and cost-effectiveness of plans to roll out seven-day GP services across England by 2020, according to a damning report by a financial watchdog.

The DH set 'high-level objectives' for improving access despite having a 'limited understanding' of pressures in general practice, according to the report from the National Audit Office (NAO).

NHS leaders have failed to demonstrate that plans for a seven-day GP service are cost-effective, the NAO said, warning that it had found no evidence that the DH or NHS England 'fully understand the effect of this commitment to extend hours on continuity of care or other arrangements for providing general medical services outside of core hours'.

It said that extended hours plans equated to a 3.4% rise in GP appointments nationally. But the NAO warned that extended hours 'may prove expensive compared to existing services' and that it was unclear if extended hours were currently being provided in areas where the service was most needed.

There was a 'clear overlap' between existing out-of-hours services and plans for extended access - forcing the two to compete for the same staff, and leaving commissioners at risk of paying for the same service twice, the NAO warned.

GP workforce

Plans to increase the GP workforce by 5,000 look likely to slip, the watchdog added, warning they were 'at particular risk from falling retention and increases in part-time working'. It also highlighted concerns that stretching the workforce over extended hours could undermine continuity of care, which was valued by growing numbers of patients with long-term conditions.

The GPC said the report showed that government plans to extend GP access were 'in disarray', while the RCGP backed NAO warnings about access plans but hit out at comments by the watchdog criticising GP practices that close during part of their core hours.

The NAO report says that the DH and NHS England have 'increased the funding available to general practice and NHS England has sought to make allocations to local areas fairer'. But it adds: 'However, they have not yet fully evaluated the cost-effectiveness of their commitments and are seeking to extend access despite failing to provide consistent value for money from existing services'.

The report also warns that incentives for practices to widen skill mix to tackle the growing GP workforce shortage were 'not yet aligned' and that CCGs with delegated primary care commissioining powers were struggling to understand whether services met patients' needs.

Seven-day GP service

GPC chair Dr Chaand Nagpaul said: 'This report is further evidence that the government’s plans for extending patient access are in complete disarray.

'Policymakers have underestimated the number of GPs required to deliver their promises by almost 2,000. This comes at a time when the NHS is already suffering from a chronic shortage of GPs with one in three practices having unfilled doctor vacancies. There are further serious shortfalls in the number of doctors choosing to train as GPs and senior GPs are choosing to retire early or leave the NHS due to increasing pressures.

'Given that funding in general practice has failed to meet patient demand, NHS England and commissioners need to fully consider the consequences of their plans to extend access. To proceed without any sort of evaluation into the cost-effectiveness or the consequences of its objectives is irresponsible.'

RCGP chair Professor Helen Stokes-Lampard said: 'The NAO hits the nail on the head by questioning the cost-effectiveness of forcing GP surgeries to deliver routine services seven days a week in the current climate. Unfortunately, it fails to demonstrate a clear understanding of the enormous pressures GPs are under – and the valiant job they do – in trying to deliver care to millions of patients every day, in increasingly difficult circumstances.'

GP opening hours

The college chair hit out at NAO criticism of practices that close during part of their core hours, however. The NAO report is critical of the GP contract, highlighting the fact that GP contracts exist 'in perpetuity' as a potential barrier to commissioners redesigning services to fit patients' needs.

It points to significant variation between practices in how they interpret opening during core hours, and suggests that practices closing early on one day a week 'may not be meeting the needs of their patients.

Professor Stokes-Lampard said: 'When practices close temporarily during core hours, there are often very good reasons for doing so, related to ensuring high quality patient care.

'On occasions where practices might have to close for a short time, perhaps for staff training, adequate cover arrangements will always be put in place, and we make sure that, wherever possible, patients are fully informed well in advance.

'It’s also the case that while a practice may be temporarily closed to patients, it does not mean that care isn’t being delivered - GPs may still be using this time to conduct telephone or online consultations for patients, or by making home visits. This is especially the case for practices with fewer GPs who cannot leave other clinical staff without GP cover whilst they go out on home visits, and so the practice has to close temporarily.'

She added: 'General practice is the most cost-effective part of the NHS and it’s very disappointing that the NAO has chosen to criticise hardworking and hard pressed GPs rather than praising them for the sterling work they are doing to improve care and keep patients safe.

'We desperately need thousands more GPs, not just in England but right across the UK  if we are to keep on doing our jobs and deliver the care our patients need and deserve.'

House of Commons public accounts committee chair Meg Hillier (Lab, Hackney South and Shoreditch) said: 'The government is trying to shoehorn in seven-day access to general practice without a clear idea of the additional costs or benefits it will bring patients or taxpayers.

'As the health system extends practice hours across the country, it must not lose sight of the need to get the basics right and end the ongoing postcode lottery for patients’ access to their GPs.'

Head of the NAO Amyas Morse said: 'The DH and NHS England have set some challenging objectives for improving access to general practice, have increased available funding and sought to make allocations to local areas fairer.

'They are, however, seeking to improve access despite not having evaluated the cost- effectiveness of their proposals and without having consistently provided value for money from the existing services. Without a more co-ordinated approach and stronger incentives to secure the desired results, the NHS is unlikely to get optimal value for money.'

Health minister David Mowat said: 'Not only does evidence show that extended GP access is helping to relieve pressure on other parts of the health service such as A&E, with 17m patients already benefitting from evening and weekend appointments – we will ensure that everyone in the country gets this by 2020.

'We’re also relieving pressure on GPs by cutting red tape and investing an extra £2.4bn to recruit 5,000 more doctors – in fact, fill rates for GP training this year were at a record level.'

An NAO spokesman said: 'The NAO seems to be criticising the rather obvious fact that it inevitably costs more to provide evening and weekend urgent primary care services than it does during Monday-Friday, 9-5. The alternative would be that patients simply head to A&E, with all the consequences that brings for more major cases.

'No one is suggesting each individual GP practice should offer this extended access, but there's quite wide agreement that - as GP numbers expand - practices do need to club together to offer this service.'

Before commenting please read our rules for commenting on articles.

If you see a comment you find offensive, you can flag it as inappropriate. In the top right-hand corner of an individual comment, you will see 'flag as inappropriate'. Clicking this prompts us to review the comment. For further information see our rules for commenting on articles.

comments powered by Disqus
Follow Us: