Scrap Sunday GP appointments, review advises

Additional hours in general practice should be provided on weekdays and Saturday mornings and be used for urgent problems rather than for bookable appointments, a review carried out for NHS England has concluded.

The independent analysis of the first wave of pilot sites offering extended services has shown that patients had little desire to see their GP on a Sunday and that few took up appointments on Saturday afternoons.1

The BMA said that the findings raised “serious concerns” about the government’s approach to seven day services for general practice, which has resulted in “precious NHS resources being wasted on keeping near empty practices open and staffed.”

The government announced the £50m (€70m; $75m) Challenge Fund, now called the Prime Minister’s GP Access Fund, in October 2013 to introduce seven day access to routine GP services in England by 2020.2

The evaluation of the first 20 pilot sites looked at how they delivered their upgraded services over a year from April 2014. It found that most sites experienced very low demand for appointments on Sundays and that many also reported low demand on Saturday afternoons and evenings.

For example, in Darlington between October 2014 and March 2015 just over half (54%) of Saturday appointments and only 12% of Sunday appointments were booked.

Doctors in Hambleton, Richmondshire, and Whitby Clinical Commissioning Group abandoned extended hours in June after finding that the usage rate of 50% to 60% was not sustainable.3 It also reported that focusing on this aspect of work put some GPs off engaging with other parts of the programme.

Overall in the pilot sites there was a 15% reduction in the number of patients who presented with minor ailments at hospital emergency departments. This compared with a 7% reduction in similar attendances nationally over the same period. But there was no difference in numbers of emergency admissions or use of out of hours services.

The pilot projects cost £45m, with the average cost of an extended hour at a practice being between £200 and £280 or £30 to £50 per appointment.

The savings from fewer emergency department attendances in the 13 pilot sites with a significant reduction would be £3.2m a year, the analysis calculated.

But many of the sites had problems recruiting GPs and filling shifts. Some sites relied on incentives to GPs to deliver the programmes, and this may not be sustainable in the long term, said the report. “These are issues likely to face all local health economies progressing towards extended access service models,” it added.

The report concluded that patients would be best served by more GP hours from Monday to Friday or on Saturdays, particularly Saturday mornings, and that where weekend appointments were offered these should be reserved for urgent care.

Responding to the report, Chaand Nagpaul, chair of the BMA’s General Practitioners Committee, said, “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.

“The cost of providing care during these hours was significantly higher than routine GP practice appointments during the week. At a time of extreme pressure 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. 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.”

Maureen Baker, chair of the Royal College of General Practitioners, 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.

“Access to GP services is extremely important, but prioritising weekend and evening access must not come at the expense of services during normal hours, so that patients end up worse off.

“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.”