Access to care

Part of Inquiry into the quality of general practice in England

A range of factors contribute to whether patients feel they have good access to general practice care, including practice location, opening times, ease of arranging appointments, and speed of access.

Performance by access criteria is now part of the quality-monitoring system for general practice. But patients still complain of trade-offs, for instance between speed of access and seeing the practitioner of choice.

Related document: A rapid view of access to care

What did we explore?

To inform its work, the Inquiry panel commissioned a research project to describe what good-quality access to GP care looks like, and how it can best be measured. A rapid view of access to care provides a framework for assessing access, and looks at the implications for future general practice provision. The paper's authors are Seán Boyle, an independent health planning and policy consultant; John Appleby, Chief Economist, Health Policy, The King's Fund; and Tony Harrison, Fellow, Health Policy, The King's Fund.

What have we learnt about access to GP care?

In March 2010 the Inquiry held a seminar on access to care with participants including GPs, practice nurses, NHS executives, health academics and patient representatives.

Key issues raised in discussion include:

Should the '8am phone lottery' have become the established (and accepted) route into same-day care?
Is improved access inevitably in tension with quality of clinical care and continuity of care?
How can an access system best balance a patient’s objective and subjective need to see a GP?

What's your view?

During the inquiry, we asked for your opinions on this care dimension. You can read comments submitted below.

Comments

Despite existing quality measures supposidily ensuring you can get a GP appointment within 48 hours frequently that is not the case. Now this access target has been "abolished" already practices are flaunting this and telling patients to ring back on a daily basis to try and book an appointment as and when slots are released. Even though these results are frequently reflected in the DoH patient surveys practices continue to receive vast sums of money via QOF for providing this very poor service.

I am 50 years old and have only ever had one Gp who was capable, he left the NHS nd now only sees private patients. My last practice the GP's strolled in late, spent the consultation time looking at the computer screen and more often than not prescribed a totally useless medication.

Access for clients who can be seen in a general practice setting is poor to appalling with usual excuses being that the client group is difficult or the surgery doesn't possess the necessary skills or that the general population wouldn't accept addicts in the waiting room. Where surgeries do provide care in a coordinated and supported fashion addicts recover well and go on to change behaviour and become integrated into communities. If more doctors were able to coordinate this support after specialised input more addicted people would be able to move on to having productive and positive lives.

Is the Inquiry considering the links between spatial planning and access to primary care?

There are some potential tensions between the proposed national commissioning board's role as commissioner of primary care and local work by the proposed health and wellbeing boards, together with the roles of local planning authorities (predominantly district and borough councils). There needs to be more of a joining up of approaches where significant population change as a result of spatial planning places more pressure on primary care services.

Will the national commissioning board take a lead on workforce planning for GPs as well?

I have been a partner in various practices in the Welsh Valleys for many years. Long before access became a political football, I had a strong interest in providing better access. I initiated various different systems to try to address the issue and indeed had some success. Some systems definitely worked better than others. However, without a doubt, the patient's view takes a different stance to the GP view. In my view it would take a much better GP to patient ratio to improve access substantially and to satisfy patient demand.

In my opinion what is needed is better education of patients regarding appropriate use of the GP and a debate about the level of access which provides safety for patients and is affordable. The top-down target of 48 hours fails completely in every respect.