GPs urged to commit to seven-day service or lose funding

Media captionDr Chaand Nagpaul, BMA: “It’s an insult”

GPs in England must keep their surgeries open for longer to meet demand from patients, or risk losing funding, Downing Street has warned.

It said many patients were going to under-pressure AE departments because they could not get appointments.

The government wants to see surgeries open between 08:00 and 20:00, seven days a week, unless they can prove the demand is not there.

The British Medical Association accused ministers of “scapegoating” doctors.

Downing Street said surgeries should do more to ensure they offer appointments in the evening and at weekends.

It said: “Most GPs do a fantastic job, and have their patients’ interests firmly at heart.

“However, it is increasingly clear that a large number of surgeries are not providing the access that patients need – and that patients are suffering as a result because they are then forced to go to AE to seek care.

“It’s also bad for hospitals, who then face additional pressure on their services.”

It comes as figures show more than four in 10 hospitals in England declared a major alert in the first week of the new year as they faced unprecedented pressures.

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Number 10 said ministers had been shown evidence that some GP surgeries were failing to tell patients about extending hours for appointments or ensuring they were at convenient times.

It said those who were not seen outside working hours were “left with little option” but to go to AE.

32,628

GPs in England

  • 5,000 more planned for 2020

  • 1 in 3 considering retirement in next five years

  • 13% of GP training places went unfilled last year

Downing Street said the prime minister wanted to help reduce pressures on hospitals in a number of ways:

  • Ministers may ask GP surgeries to use a new appointments tool to submit appointments data
  • GPs would receive extra funding for offering extended hours only if they could demonstrate they were offering appointments which patients wanted and were advertising them properly
  • Surgeries receiving extra cash for longer opening times would be asked to expand their online services for patients to free up time for consultations and treatment

Figures from the National Audit Office show 46% of GP surgeries closed at some point during core hours – with 18% closing at or before 15:00 on at least one weekday.

Three-quarters of those received extra funding in 2015-16 to provide access outside of core hours, the government said.

The director of acute care for NHS England, Professor Keith Willett, has estimated that 30% of patients attending AE would be better cared for elsewhere in the system, it added.

‘Close to the precipice’

But the British Medical Association (BMA) accused ministers of trying to “deflect blame” on to doctors rather than address the NHS funding crisis.

GP committee chairman Dr Chaand Nagpaul said pressure on AE services was down to seriously ill patients for whom seeing a GP would not prevent a hospital admission.

The government must “take responsibility” and outline an emergency plan to tackle NHS under-resourcing, he said.

Professor Helen Stokes-Lampard, chairwoman of the Royal College of GPs said the “whole of general practice and primary care” was “close to the precipice” after being “under-funded and under-resourced for a decade”.

Promises of more staff and resources had yet to reach the front line. She said: “So to put pressure on a system that’s already cracking is unhelpful and it’s going to demoralise GPs further.”

Hospital hub

Health think tank the Nuffield Trust’s chief executive Nigel Edwards said the problem was capacity, not timing.

“If you haven’t got more GPs and more practice nurses to do it, you haven’t increased the number of appointments, you’ve just put additional pressure on a service that’s already under a very severe level of pressure,” he said.

The GP controversy follows a National Audit Office report which this week said plans to increase access to GPs had not been weighed up for their cost-effectiveness.

The government said ministers believed GP surgeries had a “vital role” to play in alleviating pressure on AE.

It pointed to schemes such as the Integrated South Kent Coast pilot where 110,000 patients registered with 18 practices around a local hospital hub can book appointments from 08:00 to 20:00, seven days a week.

A 14% increase in funding to general practice will ensure there will be about 5,000 more doctors by 2020, it added.


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