The next government should be wary of promising top-down targets for faster GP appointments

Politicians should be wary of blanket GP targets for face to face appointments or appointments within 24 or 48 hours, because without enough GPs in post these are likely to backfire and risk creating a worse service for patients. These top-down measures can make it harder for GPs to prioritise urgent cases and for patients to book in an appointment at a convenient time or to see their own doctor, warns a leading health think tank.

Policies to speed up access to scarce appointments have been successively pursued against the backdrop of falling numbers of full-time equivalent GPs per person (a fall of 1,963 between Mar 2016 and Dec 2023).

Current policies have neglected the benefits of patients seeing the same doctor and the number doing so is falling. Of 42% of people who have a preferred doctor, only 35% said they usually saw them, this has fallen from 50% in 2018. Continuity of care is a good ambition which improves people’s health and reduces A&E visits. However, a recovery must start with those who need it most in the context of the difficult staffing situation.

The Nuffield Trust argues that at a time of scarce resources, the manifesto commitments of political parties should support GPs to provide the right care to their patients based on need rather than an oversimplified focus on speed of appointment which pushes too many people through a daily 8am logjam at the expense of continuity of care and the benefits of other types of appointments which some patients will prefer.

What health and care need from the next government: General practice and dentistry, published by the Nuffield Trust and funded by the Nuffield Foundation sets out a series of policy ‘tests’ for addressing the challenges in general practice and dentistry as political parties publish their manifestos for government.  The Nuffield Trust urges the next government to:

• Improve access to the same GP for those with greatest need and would benefit most - with complex or ongoing clinical problems –  approximately 20% of registered patients . The next government should consider a benchmarking system to help patients choose practices based on access to the same GP.
• Not to seek a blanket target for GPs to offer all appointments within a certain number of days or hours which distorts staff resources and limits patients. Clinicians should be able to make their own judgement on speed of appointments judged by patient need.
• Not to have a blanket requirement for all patients to have been offered a face-to-face appointment for any interaction as this isn’t needed for some appointments including follow up discussions and routine checks or where a patient is able and feels comfortable using the phone or online forms.
• Requiring practices to offer bookable appointments in advance for vaccinations and ideally with a GP who knows them for ongoing health conditions or medication reviews. The GP patient survey shows that one -in-four patients (23%) want the choice to book ahead for a non-urgent appointment, and more than one quarter (25%) of these report being unable to do so.
• Rather than meeting ratios or targets for appointments offered in a time slot or face-to-face, it would be more beneficial for patients if practices were held to account on overall patient satisfaction with making appointments and the type of appointment they were offered through the annual GP survey.

Nuffield Trust Senior Fellow Dr Rebecca Rosen, said:

“Easy access to GP appointments is the public’s top priority for the health service so this should be front and centre of the manifesto commitments on improving the NHS.

“But for too long the approach to general practice has been too simplistic. Policy makers have pushed to get people into appointments as quickly as possible, but many want to be able to book convenient appointments for jabs or a check-up with their own doctor in advance, being forced to call at 8AM for a slot the next day is just not helpful for many people, including some with the greatest needs. Even a more cautious 7-day target, as announced by the Liberal Democrats, is just not relevant for some patients."

“Manifestos need to demonstrate commitment to building and retaining GP numbers and investing in technology to identify which patients most need help, to reduce the underlying pressure on the service.

“The next government must resist pledges which do not allow for the flexibility that both patients and clinicians need. We won’t dramatically increase GP numbers overnight so it is imperative that clinicians and primary care staff can innovate and work around the needs of the patients and populations they know best.”

Ends.