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Tuesday 23 July 2019
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How important is extended GP access to practices and patients?

NHS England is asking CCGs to provide extended access to GP services by 1 October 2018

As the Government forges ahead with the rollout of extended GP access, Valeria Fiore examines what impact it’s really having, and the difference it’s likely to make to patient satisfaction with general practice. 
 
NHS England is currently asking CCGs to provide extended access to GP services by 1 October 2018 and the Government wants to ensure every patient has access to
 
CCGs are being asked to commission at least an extra hour and a half of evening appointments, while weekend opening will be decided according to local demand.
 
In order to help CCGs meet the target of providing extended access to 100% of the population by 1 October 2018, NHS England has pledged £138m of recurrent funding in 2017/18 and £258m in 2018/19 - rising to £500m by 2020/21.
 
Patient satisfaction
 
Guaranteeing access to GP services at evenings and weekend can favour your working population.
 
Kate Carr, practice manager at The Crookes Practice in Sheffield, said her practice has been providing full extended access since October 2015, as the service was originally tested in Sheffield as part of a Wave 2 Prime Minister Challenge Fund.
 
She says: ‘For patients the additional level of service works well because it offers more choice and flexibility, particularly for the working population. We recorded a 90% patient approval rating for this service.’
 
Patient satisfaction with general practice services is at the lowest point since records began in 2007, with patients complaining about the difficulty in booking a GP appointment.
 
So, could providing extended access to GP services boost patient satisfaction levels?
 
A study of over two million patients in England, published in the British Journal of General Practice, would argue differently. It found that ‘patient experience of making appointments and satisfaction with opening hours were only modestly associated with overall experience’.
 
The authors of the study concluded that the Government should instead improve the quality of services patient receive during normal hours by tackling the GP shortage and lack of investment in GP services.
 
They recommended policymakers in England to not assume that recent policies to increase access will result in considerable improvements in patients’ overall experience of general practice.
 
Fewer visits to A&E?
 
Another study published earlier this year in the BMJ Quality and Safety journal found no direct correlation between the levels of patient satisfaction with their GP practice's opening hours and the number of A&E visits.
 
Despite registering slightly fewer visits to A&E when better GP appointment booking systems were in place, the researchers concluded that in England, ‘realistic short-term improvements in patient experience of general practice may only have modest effects on A&E visits and emergency admissions.’
 
But Ms Carr found that her experience was different. She adds: ‘Many of the patients who attend our service [write] on their feedback forms that they would have gone to A&E had they not been offered an appointment at our hub. So we can presume it has cut A&E attendance although it is hard to get true evidence of this.’
 
Working collaboratively to meet demand
 
Providing extended access to GP services can help practices better cope with the resources they have, especially if they are working in neighbourhoods.
 
In fact, not all practices are able to offer extended access on their own. Kay Keane, practice manager at the Alvanley Family Practice in Stockport says that as part of the planning permission for the new build they are operating from, they were told that they cannot open the practice at weekends.
 
She adds: ‘At the moment, we’re trialling one practice working as the hub for all our patients in the neighbourhood.
 
‘We are working as a neighbourhood so that we can meet the requirements, it will mean that our patients go to another practice for this service.’
 
Working in neighbourhoods can allow practices to deliver the service with the resources they have available in their locality.  
 
Ms Carr’s practice is one of the six ‘satellite hubs’ providing extended access to GP services in Sheffield, all staffed by Sheffield GPs and practice staff.
 
When the services was still at pilot stage, all the practices in Sheffield were given the opportunity to sign up to the Enhancing Primary Care programme, which among other schemes financed the provision of urgent appointments with a GP on evenings and weekends.
 
The practices that joined the programme later committed to provide a GP to staff the rota in one local satellite hub, Ms Karr explains.
 
‘The hours of cover are proportionate to their practice list size and a practice contribution is based upon its list size with a commitment to provide three hours per week for a practice with a registered list of 10,000 patients,’ she adds.
 
The service should offer access to a wide range of healthcare professionals, as most of the demand can be dealt with by non-GP staff, Ms Karr continues.
 
‘For example, we offer appointments for a variety of clinical staff, including GPs, nurses, HCAs, physiotherapists,’ she adds. ‘Nearly every practice is signed up to [provide extended access through the hub] and it means that all our GP shifts are covered by GPs who work in the city and understand the system well. It has not been a problem to ensure the shifts are covered across the city.’