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| Seven-day working for GPs costs more and doesn’t get results | |
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| My practice started offering Saturday morning GP appointments as well as weekday slots from 8am. Previously, our surgery opened Monday to Friday from 8.30am to 6.30pm with some evening appointments until 7.30pm. The Saturday slots are now offered as part of a group of local practices (on a rota basis) to all patients across the practices for routine pre-bookable appointments. There are many such pilots across the country – which started in 2013 as part of the then prime minister’s £50m challenge fund. Some, such as those in Greater Manchester, offered Saturday and Sunday urgent and routine appointments in addition to extended weekday access. Others, like ours, offer additional weekday and Saturday morning access for routine appointments only. The government has committed to another year of extended access despite dubious benefits of the first wave. | My practice started offering Saturday morning GP appointments as well as weekday slots from 8am. Previously, our surgery opened Monday to Friday from 8.30am to 6.30pm with some evening appointments until 7.30pm. The Saturday slots are now offered as part of a group of local practices (on a rota basis) to all patients across the practices for routine pre-bookable appointments. There are many such pilots across the country – which started in 2013 as part of the then prime minister’s £50m challenge fund. Some, such as those in Greater Manchester, offered Saturday and Sunday urgent and routine appointments in addition to extended weekday access. Others, like ours, offer additional weekday and Saturday morning access for routine appointments only. The government has committed to another year of extended access despite dubious benefits of the first wave. |
| The health secretary, Jeremy Hunt, has cited lack of GP services as one of the reasons for A&E and acute admission pressures in hospitals. Indeed, studies have shown that seven-day GP access reduces attendances at A&E for minor illnesses but has little impact on emergency hospital attendances for serious medical conditions. | The health secretary, Jeremy Hunt, has cited lack of GP services as one of the reasons for A&E and acute admission pressures in hospitals. Indeed, studies have shown that seven-day GP access reduces attendances at A&E for minor illnesses but has little impact on emergency hospital attendances for serious medical conditions. |
| A recent study from Greater Manchester showed that providing extended seven-day GP access to patients across 56 practices reduced A&E attendances for minor ailments by 26% (in comparison to 469 practices that provided routine access). This equated to savings of £767,867 through reduced A&E visits – however, this extended GP access scheme cost around £3.1m, which included evening appointments until 9pm on weekdays and both Saturdays and Sundays (across a range of times). But hospital visits for minor ailments form only a proportion of total A&E visits – this study showed that extending GP access led to only a small reduction of 3.1% in total A&E visits. So overall, the scheme cost three times more than it made in savings. | A recent study from Greater Manchester showed that providing extended seven-day GP access to patients across 56 practices reduced A&E attendances for minor ailments by 26% (in comparison to 469 practices that provided routine access). This equated to savings of £767,867 through reduced A&E visits – however, this extended GP access scheme cost around £3.1m, which included evening appointments until 9pm on weekdays and both Saturdays and Sundays (across a range of times). But hospital visits for minor ailments form only a proportion of total A&E visits – this study showed that extending GP access led to only a small reduction of 3.1% in total A&E visits. So overall, the scheme cost three times more than it made in savings. |
| There has also been further evaluation of the impact of seven-day access on medical admissions of elderly patients at weekends. In central London seven-day GP cover cut weekend A&E visits by 18% and weekend hospital admissions fell by 9.9% (mainly in elderly patients). But there have been many more disappointing outcomes from the extended access schemes with many areas discontinuing the pilots early or cutting their hours. | There has also been further evaluation of the impact of seven-day access on medical admissions of elderly patients at weekends. In central London seven-day GP cover cut weekend A&E visits by 18% and weekend hospital admissions fell by 9.9% (mainly in elderly patients). But there have been many more disappointing outcomes from the extended access schemes with many areas discontinuing the pilots early or cutting their hours. |
| In areas where extended opening hours are only offering routine appointments, like ours, cost-savings through reduced A&E attendances or emergency admissions is even more questionable since we are not seeing urgent or acute problems – it is the latter group of patients who are more likely to go to out-of-hours services or to A&E. | In areas where extended opening hours are only offering routine appointments, like ours, cost-savings through reduced A&E attendances or emergency admissions is even more questionable since we are not seeing urgent or acute problems – it is the latter group of patients who are more likely to go to out-of-hours services or to A&E. |
| Nevertheless, NHS England has used some of this early data to extend the seven-day GP access services. In 2015-16, it invested £100m. At a time when both primary and secondary care is seeing unprecedented budget cuts and rationing of “unnecessary” or even routine services, it makes little sense to waste money on weekend opening . | Nevertheless, NHS England has used some of this early data to extend the seven-day GP access services. In 2015-16, it invested £100m. At a time when both primary and secondary care is seeing unprecedented budget cuts and rationing of “unnecessary” or even routine services, it makes little sense to waste money on weekend opening . |
| The cost per total extended hour is up to £280, with practices needing to cover premises’ costs and reception, nurse and GP hours. Staffing these hours has been especially problematic for some areas that do not have enough GPs. Within my own practice, there is little appetite to work more. Until a few years ago I used to work GP out-of-hours sessions until it became difficult to manage these with a young family. As a partner in the hub of practices, I am doing the Saturday morning sessions. The 12 slots are booked by a mix of people, some of whom could come during the week. | The cost per total extended hour is up to £280, with practices needing to cover premises’ costs and reception, nurse and GP hours. Staffing these hours has been especially problematic for some areas that do not have enough GPs. Within my own practice, there is little appetite to work more. Until a few years ago I used to work GP out-of-hours sessions until it became difficult to manage these with a young family. As a partner in the hub of practices, I am doing the Saturday morning sessions. The 12 slots are booked by a mix of people, some of whom could come during the week. |
| Expensive extended access is not likely to be sustainable, and my concern is where is this money likely to be diverted from? And should we not put it to the public to decide whether they would like seven-day provision or improved access within existing GP hours? | Expensive extended access is not likely to be sustainable, and my concern is where is this money likely to be diverted from? And should we not put it to the public to decide whether they would like seven-day provision or improved access within existing GP hours? |
| Evidence suggests that improved access within existing, standard hours leads to a more effective way of reducing patients’ use of out-of-hours services than extending opening times. But this requires more GPs and more rooms to put them in. and better signposting so patients can see nurses, pharmacies and health care assistants rather than only a GP. It makes no sense to run services on a shoestring during the week, offering limited appointments to patients – because you are spreading staff thinly across the week. We should be offering more daytime appointments. This requires a commitment from the government to help primary care tackle its workload and funding crises, rather than persisting with its obsession of seven-day working. | Evidence suggests that improved access within existing, standard hours leads to a more effective way of reducing patients’ use of out-of-hours services than extending opening times. But this requires more GPs and more rooms to put them in. and better signposting so patients can see nurses, pharmacies and health care assistants rather than only a GP. It makes no sense to run services on a shoestring during the week, offering limited appointments to patients – because you are spreading staff thinly across the week. We should be offering more daytime appointments. This requires a commitment from the government to help primary care tackle its workload and funding crises, rather than persisting with its obsession of seven-day working. |