£50 million in the wrong direction?

So £50m is going to be spent on extending GP opening hours. Inevitably this means that patients will find it harder to see their own doctor (even if they know who he or she is). This flies in the face of what we increasingly know to be important about continuity of care.

NHS England recently produced analyses that show that emergency admissions for ambulatory care sensitive conditions are most impacted by responses to the GP Patient Survey in terms of:

  • Ability to see your preferred GP (for patients who say they have one)
  • Ability to speak to someone at the surgery on the phone

We have a forthcoming publication (in Emergency Medical Journal), also looking at GP Patient Survey scores, which shows that out of hours attendance relates to:

  • Convenience of opening hours (the strongest predictor among a range of access variables)
  • Ability to see your preferred GP (for patients who say they have one)

Surprisingly the relationship with convenience of opening hours was strongest for those not in work, suggesting that extended hours isn’t necessarily the answer. This also fits work recently done for the DH evaluating the GP Choice pilots, which showed that weekend opening (Saturday and Sunday) was not an important factor in determining patients’ choice of practice.

Richard Baker has also done research which shows that attendance at A&E is related to the ability to see a doctor of your choice in your practice.

Taken together this provides support for Jeremy Hunt’s focus on having an identifiable doctor responsible for patient’s care (in both hospital and general practice). Yet what’s the money being spent on? Longer opening hours.

Getting to see any old doctor is at times important for patients, but many people want to see a doctor they know and doctors find it very hard to deliver high quality care to patients (especially complex ones) who they don’t know. Practices need to be organised to provide this, and not just be open for longer hours. This is fully in line with the ‘responsible doctor’ agenda that the Secretary of State is already promoting, but seems to be at odds with the £50m Prime Minister’s Challenge which is all about opening hours.

The DH often looks to the US (perhaps surprisingly) for models of care. When I talk to American colleagues, they’re amazed that English patients can’t identify ‘my doctor’. Doctors need continuity to provide safe care, and our increasingly complex elderly patients need it too. When will the government drop this populist fixation with opening hours?

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