Medical Centre

It is often assumed that providing easier access to community-based general practice during evenings and weekends can reduce demand for emergency and other unscheduled care services, promoting more appropriate care and reducing the costs associated with expensive hospital-based treatment. For example, in England’s NHS there is political pressure to expand general practice surgeries’ opening hours to progress towards a ‘seven-day NHS’.

When considering extension of primary care opening hours in England, it is useful to compare primary care access across other countries in the European Union. Despite differences in healthcare commissioning and funding, European countries face comparable challenges such as ageing populations and increases in chronic conditions and mental health problems, all of particular relevance to primary care.  In a paper published in the Journal of the Royal Society of Medicine, we examined England’s current in-hours general practice services relative to those of European countries in order to better contextualise the debate on extending general practice opening hours.

We found that standard opening hours in England already exceed those of most other European countries, and patients in the UK are more satisfied with out-of-hours access to general practice than patients in many other European countries. Achieving easier access to primary care services seven days per week would require significant investment, and must compete with other NHS priorities; politically attractive priorities should not to have an undue influence in shaping resource allocation.

The existence of true patient demand for extension of general practice opening hours in England is not yet fully established and evidence for a correlation between increasing in-hours provision and decreased emergency department use is inconclusive. Furthermore, the demand for services likely varies based on local demographics and disease burden; if general practice opening hours were to be extended, those regions with the highest demand for care should be prioritised.

Hence, we suggest that policy-makers in England should focus on improving access to GP appointments during normal opening hours, instead of spending scarce NHS resources on very poor value for money extended opening hours schemes.

https://doi.org/10.1177/0141076818755557

Read Seven-day access to NHS primary care: how does England compare with other European countries? in full

A study published in the journal BMJ Quality and Safety concluded that extending GP opening hours will not ease the rising burden on Accident and Emergency departments. The observational study was led by Imperial College London. Lead author Dr Thomas Cowling from Imperial College’s Department of Primary Care and Public Health and colleagues compared patients’ experiences of GP surgeries with the number of Accident and Emergency visits in their areas in England from 2011-2012 to 2013-2014. They examined reports from NHS England’s annual GP Patient Survey, and included patients registered to 8,124 GP surgeries.

We measured levels of patient satisfaction using three factors: the ease of making an appointment, opening hours, and overall experience. They then matched these responses with A&E departments in their area to observe any correlation with the number of visits to A&E. Overall, areas where patients were happier with the ease of making appointments, which could be for example by using online booking systems, saw slightly fewer visits to Accident and Emergency departments. However, satisfaction with surgery opening hours and overall patient experience seemed to have no impact on Accident and Emergency visit rates.

The study suggests that better satisfaction with GP hours, for example because of extended opening hours, does not affect the number of visits made to A&E in their geographical area. However, making the appointment booking process easier for patients was associated with slightly fewer Accident and Emergency visits in that area. Our research supports finding alternative options for easing the burden on Accident and Emergency departments, and casts doubt on the Government’s proposals to extend GP surgery hours to ease the burden on Accident and Emergency departments.

We measured satisfaction with hours without linking explicitly them to daytime weekday or evening and weekend appointment availability. We hypothesised that although weekend and evening appointments are convenient for healthy, working aged adults, those who are likely to need medical attention more urgently are older people or those who are chronically ill and not currently working full time.

Senior author Professor Azeem Majeed from Imperial’s School of Public health, who is a practising GP, said: “The government must find alternative ways to handle current pressures on Accident and Emergency departments. This could include for example improving access to GP appointments during normal opening hours rather than spending scarce NHS resources on extended opening schemes.”

Dr Cowling, also from Imperial’s School of Public Health, said: “It makes sense to think that extending GP hours will ease the burden on other NHS services, but our study suggests this might not be the case with Accident and Emergency.”

The study was reported in a number of media outlets including the Times, Belfast Telegraph, OnMedica, Pulse and Eureka Alert.

Read Extending GP opening hours will not ease the rising burden on A&E departments in full