Why access targets don’t improve patient access

NHS England imposed a new contract on GPs in May. Among the rules and regulations is a new access requirement, which is seemingly designed to get patients seen sooner. The reform follows media and public pressure for more GP appointments. A lot of headlines call for more appointments, each placing the blame somewhere slightly different. 

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We’ll look later at the real reason some patients might not be getting the access they need, but first here’s why the target in the new contract won’t help. 

The new patient access rule 

As far as patient access goes, the new contract doesn’t provide any useful framework or reform to support a surgery that’s under pressure and understaffed. It’s a largely meaningless reform that will leave GPs exposed to the same unfair media attacks. 

When a patient contacts a practice, 

‘…the contractor [GP surgery] must: 

  1. invite the patient for an appointment, either to attend the contractor’s practice premises or to participate in a telephone or video consultation, at a time which is appropriate and reasonable having regard to all the circumstances, and the patient’s health would not thereby be jeopardised; 
  2. provide appropriate advice or care to the patient by another method 
  3. invite the patient to make use of, or direct the patient towards, appropriate services which are available to the patient, including services which the patient may access themselves, or 
  4. communicate with the patient 
    - to request further information 
    - to convey when and how the patient will receive further information on the services that may be provided to them, having regard to the urgency of their clinical needs and other relevant circumstances.’ 

What does the new rule mean for patient access? 

In short, very little. 

The option to ask a patient to call back later is no longer available, but GPs may take other courses of action that don’t involve an actual appointment.  

If a patient feels like a GP appointment is hard to come by, the new contract is likely to make no difference. A quick look at the instructions in the contract reveals how little it offers to patients or practices. The main problem is its implied definition of ‘access’. 

Let’s look at the steps that a practice is allowed to take when a patient gets in touch. 

  1. Offer an appointment
    This is the ‘ideal’ next step from an access point of view, which is even more effective if medical receptionists can triage patients. 
  2. Offer advice 
    The option is vague enough to allow a wide interpretation. Presumably, the surgery could advise bed rest or a home remedy to relieve discomfort, and suggest the patient monitors their symptoms. An overwhelmed practice may lean heavily on that option, and if a patient is unhappy with the availability of GP appointments, this won’t do very much to satisfy them. It is also barely any different from the now-forbidden request for the patient to call back later. 
  3. Signposting 
    The reality is that GPs are struggling to handle the demand for care, and they will direct patients elsewhere where it makes sense to do so. Meanwhile, patients who have heard that the new contract will mean greater GP access will be disappointed. 
  4. Communication 
    Finally, the practice can request more information or provide a timeframe for information on the next step. Once again, if a patient believed that care is not available as immediately as it should be, they won’t be satisfied by receiving a date when they’ll learn what treatment they might have. 

GPs want to treat more patients, but improving access is not achieved by stretching the definition of access. 

How can GP practices genuinely improve patient access? 

Quite simply, we need more GPs. 

There are some interesting reforms which may have potential. One of those is the use of pharmacy prescriptions to relieve the pressure on GPs. Those steps are interesting and worth considering, but the issue is much for fundamental. 

BMA data shows that patient numbers are increasing, but GP numbers are falling. On average, there are 2,285 patients to every GP — up 18% since 2015. There are 0.44 fully qualified GPs per 1,000 patients in England. That’s down from 0.52 in 2015. 

Until we find a way to encourage more GPs into the profession, and to stem the tide of doctors leaving general practice, then no contractual obligation will make a difference. 

Meanwhile, at MCG Healthcare we’re working to find the best matches between GPs and practices, so that surgeries are staffed with doctors who are best suited to their positions. We also champion and protect the mental health of primary care professionals through our GP Wellbeing Lead Dr Matt Mayer. 

If you’re a GP looking for your next role, or a practice manager in need of doctors for your surgery, call 0330 024 1345 or email hello@mcghealthcare.co.uk. 

About the author
Ash Higgs Managing Director

Ash Higgs is the Managing Director of MCG Healthcare. He has a long-demonstrated history working in recruitment and has now been involved in the medical industry for over 5 years. During this time, he has gained a strong understanding of the issues that both Primary & Secondary Care are facing regarding the recruitment of healthcare professionals.

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