General practitioner England

Last updated:

Patient access to GPs in 'complete disarray'

GP sat at desk arms folded

The Government’s drive to increase patients’ access to GPs has fallen into ‘complete disarray’, doctors have warned, after a spending watchdog questioned its value for money.

According to a report released today by the NAO (National Audit Office), extra evening and weekend GP appointments cost 50 per cent more than those during normal working hours.

It says: ‘The Department [of Health] and NHS England have not fully considered the consequences and cost-effectiveness of their commitment to extend access.’

Neither had NHS England ‘yet set out how it will assess whether local plans for spending the additional funding provide good value for money’, says the NAO.

NHS England has, however, hit back, claiming the NAO’s point about additional costs was ‘obvious’ and its criticism about value for money was plain ‘wrong’.

The report, Improving Patient Access to General Practice, also raises questions about efforts to fill gaps in the GP workforce, which auditors found were ‘at particular risk from falling retention, shortfalls in recruitment and increases in part-time working’.

Health Education England had only filled 93 per cent of GP training places in 2016/17, the report points out.

‘The DH has limited understanding of the pressure in general practice,' the NAO says.



NAO comptroller and auditor general Sir Amyas Morse said: ‘The DH and NHS England have set some challenging objectives for improving access to general practice, increased available funding and sought to make allocations to local areas fairer.

‘They are, however, seeking to improve access despite not having evaluated the cost-effectiveness of their proposals and without having consistently provided value for money from the existing services.’

BMA GPs committee chair Chaand Nagpaul said the report was ‘further evidence that the Government's plans for extending patient access are in complete disarray’.

‘There are serious shortfalls in the number of doctors choosing to train as GPs and senior GPs are choosing to retire early or leave the NHS due to increasing pressures,’ Dr Nagpaul added.

‘Given that funding in general practice has failed to meet patient demand, NHS England and commissioners need to consider the consequences of their plans to extend access.

‘To proceed without any sort of evaluation into the cost-effectiveness or the consequences of its objectives is irresponsible and could lead to much needed investment being spent on measures which don’t adequately meet patient needs.’

NHS England said the NAO seemed to be ‘criticising the rather obvious fact that it inevitably costs more to provide evening and weekend urgent primary care services than it does during Monday to Friday, nine to five’.

‘The alternative would be that patients simply head to [the emergency department], with all the consequences that brings for more major cases,’ as spokesperson added.

‘The NAO is wrong to criticise the value for money of general practice, given that the per-patient cost of a year of GP care is less than the cost of just two [emergency department] visits.’

Read more from Keith Cooper and follow on Twitter.