Doctors’ leaders say plans for seven-day GP access ‘in complete disarray’

By The Press Association11th January 2017News EnglandGovernment / Politics, GPs, News England, NHS, Primary Care / GP's, Recruitment / Retention

Doctors’ leaders have claimed the Government’s plans to extend access to GPs in England are in “complete disarray”, after a report warned of “difficulties” recruiting and retaining enough family doctors to deliver them.

The National Audit Office said shortfalls in training places, increased part-time working and early retirement mean there may be 1,900 fewer GPs by 2020 than health authorities had predicted.

The Department of Health has promised additional funding and 5,000 extra doctors in general practice by 2020 to meet a Conservative election promise for weekend and evening access to GPs.

But the NAO report found that the department had failed to evaluate the cost-effectiveness and consequences of the proposals or to show that they can provide value for money from existing services.

Some 46% of practices already close for part of their “core hour” opening times of 8am to 6.30pm Monday to Friday.

Funding the extended hours commitment will require at least £230 per appointment hour for every 1,000 registered patients, compared with £154 during normal opening hours, said the watchdog.

The report found that efforts by NHS England and Health Education England to boost GP numbers are “at particular risk from falling retention, shortfalls in recruitment and increases in part-time working”, with just 3,019 out of 3,250 training places (93%) filled in 2016/17, up from 2,769 the previous year.

“The latest available data on part-time working in new GPs suggest that there may be 1,900 fewer full-time equivalent GPs by 2020 than Health Education England had estimated there would be,” the NAO warned.

The chairman of the British Medical Association’s GP committee, Chaand Nagpaul, described the report as “further evidence that the Government’s plans for extending patient access are in complete disarray”.

“Policy-makers have underestimated the number of GPs required to deliver their promises by almost 2,000,” said Dr Nagpaul.

“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.”

The chairwoman of the influential House of Commons Public Accounts Committee, Labour MP Meg Hillier, accused ministers of “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”.

Ms Hillier said: “This is on top of problems for patients in accessing their GP even during a standard working week, when nearly half of all practices close at some point during supposedly core hours, and practices are struggling to recruit and retain enough doctors for existing services.”

Liberal Democrat leader Tim Farron said: “Jeremy Hunt says he wants a seven-day NHS, but under his watch GP surgeries are struggling to stay open nine to five.”

The chairwoman of the Royal College of GPs, Professor Helen Stokes-Lampard, said the report “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”.

But she added: “It seems bizarre that the NAO are questioning the cost-effectiveness of boosting the GP workforce by 5,000 over the next five years when, today alone over 1.3 million people will visit their GP surgery and GP teams are seeing 60 million more patients per year than we were even five years ago.”

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 17 million patients already benefiting 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 £2.4 billion to recruit 5,000 more doctors – in fact, fill rates for GP training this year were at a record level.”

An NHS England spokesman said: “The NAO seem 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 to Friday, nine to five.

“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, a bit like the out-of-hours duty chemist rota.

“Across much of London, Manchester and a fifth of the country, GPs are already doing this, and more areas will follow next year.

“The NAO are wrong to criticise the value for money of general practice, given that the per-patient cost of a year of GP care is less than the cost of just two A&E visits.”

Shadow health minister Julie Cooper said the report showed the Government had “little understanding of the scale of the crisis in many of our GP surgeries”.

The Labour frontbencher said: “Access to GPs has never been worse, satisfaction levels are falling, patient safety is being compromised and morale amongst GPs and their staff is at an all-time low.

“The Government’s plan to address this crisis is woefully inadequate and all depends on little more than its ability to introduce an additional 5,000 GPs and current recruitment and retention figures make even this unlikely.”