How can we improve GP access?

A recent study led by researchers from the CCHSR, in collaboration with our Exeter colleagues, has found that poor access to GPs during normal working hours is associated with increased out of hours primary care use.

In this study using data from about 567,000 patients in the 2011/12 GP Patient Survey, we found that:

  1. Inconvenient opening hours, reduced ability to see a preferred GP and inability to get an appointment were associated with more out of hours use, irrespective of age, gender, ethnicity, deprivation level, occupational and chronic disease statuses.
  2. People not in work or education were more likely to use out of hours GP than the full-time employed if they reported their surgery opening hours as inconvenient

This Emergency Medicine Journal paper was captured by national and regional media. The counter-intuitive finding in point 2 above suggests that the current government’s push for extended opening hours may not be as effective in reducing out of hours use as improving in hours access, such as improving continuity of care, and offering more appointments at times that are convenient for patients. The media coverage “invited” some interesting debate around the issue of GP access.

Much of the debate revolves around how we can improve access to GPs. One major concern that politicians, GP leaders and the public have is a lack of human and financial resources to improve access while delivering high quality care to an ageing population. Others believe that reducing strain on GP services by modifying health-seeking behaviour is crucial. The latter involves empowering patients to self-manage their conditions and to use GPs (and other health care services) more appropriately. Research has shown that this is likely to reduce A&E attendances and hospital admissions, especially for ambulatory care sensitive conditions. Readers also suggested that GPs should name and shame patients who do not attend their appointments, and charge patients who do not turn up to their appointments. These, along with the recent proposal to charge patients for booking GP appointments, are indications of increasing awareness that improving GP access cannot rely solely on managing the (limited) supply. The other pertinent issue is the need to reduce patient demand on primary care services.

Undoubtedly, shifting the supply and demand curves is not easy and will be costly. Is the £50 million PM’s Challenge Fund the answer?

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  • The Cambridge Centre for Health Services Research (CCHSR) is a thriving collaboration between the University of Cambridge and RAND Europe. We aim to inform health policy and practice by conducting research and evaluation studies of organisation and delivery of healthcare, including safety, effectiveness, efficiency and patient experience.