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Watchdog questions plans to improve access to GPs

NAO says cost-effectiveness of more GP access is untested

Adrian O'Dowd

Wednesday, 11 January 2017

Plans to increase access to GP practices by 2020 have not been properly tested to see if they will provide value for money, according to the financial watchdog the National Audit Office (NAO).

In a report* published today, the NAO said that while the government’s intention to improve access to general practice in the evenings and weekends for patients and to have an extra 5,000 GPs, both by 2020, was welcome, the Department had not evaluated the cost-effectiveness and consequences of their objectives.

Its analysis suggested that the minimum additional capacity needed by the new commitment equated to £230 per appointment hour per 1,000 registered patients. In core contract hours, the cost was an estimated £154.

NHS England had said it intended that the additional funding would also be used to cover transformation costs and deliver wider improvements in access, but had not yet set out how it would take assurance that the additional funding provided good value for money, said the watchdog.

The report discusses the most common General Medical Services contract in general practice, which stipulated that "core hours" are 8am to 6.30pm, Monday to Friday and says that while practices do not necessarily have to be open throughout these core hours, they must provide essential services at times to meet reasonable needs of patients.

However, the NAO said it had found variations in practices' opening hours during these times.

The report authors also raised concerns over NHS England and Health Education England's (HEE) efforts to increase the GP workforce, warning that these were at risk due to falling retention, shortfalls in recruitment and increases in part-time working.

Amyas Morse, head of the NAO, said: "The Department and NHS England have set some challenging objectives for improving access to general practice, have increased available funding and sought to make allocations to local areas fairer.

"They are, however, seeking to improve access despite not having evaluated the cost- effectiveness of their proposals and without having consistently provided value for money from the existing services."

Meg Hillier, chair of the parliamentary public accounts committee, said: "The government is trying to shoehorn in 7-day access to general practice without a clear idea of the additional costs or benefits it will bring patients or taxpayers."

The RCGP welcomed some of the report’s messages, but rejected its claims that too many practices were currently not open when they should be.

Professor Helen Stokes-Lampard, RCGP chair, said: "The NAO 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.

"Unfortunately, it fails to demonstrate a clear understanding of the enormous pressures GPs are under – and the valiant job they do – in trying to deliver care to millions of patients every day, in increasingly difficult circumstances.

"Today’s report also fails to recognise that when practices close temporarily during core hours, there are often very good reasons for doing so, related to ensuring high quality patient care.

"The report also ignores the fact that we are also delivering much more complex care in general practice and managing conditions that even a decade ago would have been automatically referred to hospitals.

Dr Chaand Nagpaul, BMA GP committee chair, said: "This report is further evidence that the government’s plans for extending patient access are in complete disarray.

"Given that funding in general practice has failed to meet patient demand, NHS England and commissioners need to fully consider the consequences of their plans to extend access. To proceed without any sort of evaluation into the cost-effectiveness or the consequences of its objectives is irresponsible and could lead to much needed investment being spent on measures which don’t adequately meet patient needs."

* Improving patient access to general practice. National Audit Office, January 2017.

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