DH to press ahead with seven-day GP access plans

DH officials say a review of the £150m prime minister's Challenge Fund pilots shows patients 'want to see their GP at a time that suits them' and have renewed their pledge to roll out routine seven-day GP services across England by 2020.

The review, which found 'very low' demand for appointments on Sundays, has been cited by GP leaders as evidence that the government should drop its 'obsession' with routine seven-day GP services. The RCGP has warned that seven-day GP access could cost the NHS £1bn a year.

But a DH spokeswoman said the overall findings were positive, and had buoyed the case for a seven-day NHS. 'These results show patients want to see their GP at a time that suits them, with 400,000 evening and weekend appointments in our first ever pilots. This resulted in a 15% reduction in minor A&E visits. By 2020 this approach will be rolled out across the country as part of our plan for a seven- day NHS,' she said.

Along with the reduction in minor A&E visits, the DH cites a rise in GP phone consultations as evidence of the Challenge Fund's success.

GP telephone consultations

Across 120 practices in five pilots trialling GP telephone triage and consultations, the review found a 28% rise in contacts with patients during core hours using these methods and 220% in extended hours. In Brighton and Hove, a £186,000 investment in technology to support GP telephone triage led to a rise of more than 77,000 telephone appointments - 34% of core-hours appointments now take place by telephone compared with a baseline of 10%.

The DH highlighted positive comments from GPs and managers leading the pilots.

Slough CCG chairman Dr Jim O’Donnell said: 'We rolled out the extended service inside three months, in July 2014. We have over 97% patient satisfaction rates, and 94% would recommend the service to family and friends. We’ve seen a 22% fall in demands made on our out-of-hours service, and numbers from Slough attending our local A&E and of emergency admissions have now started to fall month-on-month. This has really improved things for patients and their comments are illuminating, as are those of GPs and staff working in the service.'

Graeme Cleland, managing director of Taurus Healthcare Ltd, which is part of a Herefordshire pilot, said: 'We have developed a countywide GP and primary care service that is delivered outside of normal practice opening times via three hubs. This is a real step forward from traditional out-of-hours service provision. We have integrated in to 111 care pathways, and we are having a large number of patients that would ordinarily have attended A&E on a weekend sent to our service – and the patient feedback has been excellent.

'In one week recently,  our team of clinicians saw over 400 patients, who have all benefited from the seven-day extended access program.'

Seven-day GP access

The DH also believes that as more patients become aware of the availability of seven-day GP services, demand will rise as the 'cultural change' beds in. Officials are also hopeful that more uniform extended hours requirements in wave two Challenge Fund pilots will drive up interest from patients. Wave one pilots - the only group covered by the official review - required 'some form of improved access outside of core opening hours', while wave two pilots are specifically required to offer access 8am to 8pm on weekdays and improved access at weekends.

But the government's continued commitment to seven-day services puts it on a collision course with both the RCGP and BMA.

GPC chairman Dr Chaand Nagpaul said: 'GPs have always been committed to improving patient access and already provide a seven-day round the clock service. How we deliver further benefits to the public needs to addressed, but this independent evaluation of the challenge fund pilots 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.

GP core hours

'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.

'At a time of extreme pressures on GP services, with many practices struggling to cope with patient demand and falling resources, the government needs to learn the lessons from its own pilots. A number of those areas taking part decided to stop providing weekend sessions owing to lack of demand. Two thirds of the funding for this project was actually spent on worthwhile schemes of benefit to all patients across the week, such as improving digital infrastructure and measures that enhance collaborative working between GP practices.

'As the BMA outlined in its recent vision for the future of general practice, we need to ensure that GP services have the resources to meet the incredible demands being placed on them and not be distracted by headline grabbing initiatives which do not deliver benefits to patients.'

RCGP chairwoman Dr Maureen Baker 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 sounds 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.

'We hope that this evaluation will 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.'

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