Demand for seven-day GP service overestimated, study finds

Patient demand for a seven-day GP service has been overestimated and it is 'simply not true' to claim that stretching access over weekends is the key to improving NHS care, Nottingham academics have warned.

A report by Nottingham University Business School's centre for health innovation, leadership and learning (CHILL) looked at GP access pilots in the city and evaluated patient demand for seven-day care.

Polling carried out as part of the study found that patients wanted quick - ideally same-day - access to GP appointments, but that they did not express a strong preference for seven-day services.

The study assessed three 'weekend hub' GP access pilots in Nottingham and found low take-up of urgent care appointments. At one hub, take-up of weekend and bank holiday urgent care appointments was just 22%, falling to 18% on Sundays.

Seven-day GP service

The researchers pointed out that in other parts of England, pilots had seen take-up as low as 10% for weekend appointments.

The researchers found that demand for weekend urgent care appointments was 'far lower than anticipated and planned for' at the Nottingham pilot sites.

Of the three Nottingham pilots, the highest take-up of appointments came at a model offering mostly routine pre-booked appointments, with a limited number left open for walk-in urgent care. A total of 87% of appointments on Saturday and 78% on Sundays were used at the pilot offering this model.

Pilots offering mostly urgent care appointments had poor take-up and saw primarily patients aged under five for respiratory complaints, whereas the pilot offering mainly pre-booked appointments saw some under-5s, but saw a markedly higher take-up among 45- to 49-year-olds and among all patients aged 20 to 65 for a broader range of conditions. The researchers pointed out that this group - people of working age - was the group that extended access was initially intended to make general practice more accessible to.

Higher take-up of appointments under this model also cut costs per consultation substantially, with appointments costing around £20 in this system, and more than £100 each in the primarily urgent care model.

GP pressure

Pressure on primary care has been rising, the study points out, with increased demand, an ageing population with more long-term conditions and higher patient expectation coming at the same time as falling GP numbers and falling investment in primary care.

But the researchers point out: 'Currently, there is clearly a lack of understanding of patients’ needs and their demand for primary care access. There has been an overestimation of the demand for urgent appointments with GPs at weekends.

'This has led to an overprovision of weekend appointments. By contrast, there is a lack of appreciation for patients’ demand for same-day appointments during the week. More effective tools for understanding the factors that drive patient demand needs to be considered.'

Paul Windrum, principal investigator of the evaluation, from CHILL, said: 'There is a need to better understand the needs and preferences of different types of patient for GP services. The biggest users of primary care GP services are the elderly and the very young. These groups do not have problems accessing services during the working week. The expectation seems to be that people in full-time employment have a strong demand for weekend services, but the evidence indicates this is not the case.

'A distinction also needs to be made between urgent care and non-urgent care. There is a lack of appreciation of the demand for same-day appointments for non-urgent care services during the working week.'

CHILL research fellow Penelope Siebert and one of the authors of the evaluation, said: 'The evaluation of the different hubs clearly shows that there is not a one-size fits all solution to the issue of patient care. The variety of the pilots reflects the different local health needs and the capabilities and resources of different practices.

'The misconception that the solution to improving patient care is to open GP practices seven-days a week – is simply not true and this can be seen by looking at the take-up of weekend appointments during the pilot schemes.'

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