GP appointment plans 'unrealistic'
Pledges by the Tories and Labour to improve access to GPs appointments are unlikely to be achieved within a parliamentary term and the "public should question the promises of politicians", health experts have said.
Analysis in the British Medical Journal said the likely effects of proposed changes in access to general practice are unclear, with no firm proof that more patients getting to see their doctor will lead to fewer A&E attendances.
David Cameron has promised patients will be able to access GP surgeries between 8am and 8pm seven days a week by 2020 if the Tories are re-elected, while Ed Miliband has guaranteed appointments within 48 hours if Labour are voted in.
But the piece said these pledges may prove unrealistic, adding that the evidence behind them has not been made clear and the p roblem with access has not been precisely defined.
"The aims and rationale of the policies outlined by the Conservative and Labour parties do not seem explicit," the analysis said.
"One aim is undoubtedly to win election votes. But the aims for the NHS and for patients are less clear."
It said that around 90% of patients were able to get an appointment in 2013/14, meaning that around 10% were not. This amounts to around 33.8 million unsuccessful attempts each year (or 81 per general practice each week).
The authors said e stimates based on the GP Patient Survey suggest as many as a quarter of emergency department visits (5.8 million in 2012/13) follow unsuccessful attempts to obtain convenient GP appointments.
It said a national, cross-sectional study found an association between GPs' surgeries with a greater percentage of patients able to see a GP within two weekdays and lower rates of A&E department visits, while o ther studies suggest that greater access to general practice is also associated with lower rates of emergency admissions for specific conditions such as heart failure and stroke.
The piece said i n the GP Patient Survey, those who report worse in-hours access are more likely to report using out- of-hours primary care services.
However, the authors said the studies all use an observational, cross- sectional design, which is particularly vulnerable to confounding and the evidence is inadequate to inform national policy.
The piece, written by academics from Imperial College London and New York University, points out that more GPs are required if access is to be improved but politicians' promises of an extra 5,000 to 8,000 GPs are likely to be challenging to achieve.
It said the largest increase over a previous parliamentary term in the past 20 years was 5,414 GPs (from 2004/05 to 2008/09) under Labour.
But Labour's previous pledge for all appointments within 48 hours was "far from being achieved", it adds. Only 81% of patients ended up able to see a GP within two weekdays in 2009/10 when the party was last in government.
The analysis suggests five points of action " for policy and research if improvements in access are pursued".
These are e valuating the extended opening hours pilot scheme carried out by the Tories, m aking general practice consultation data routinely available, looking at employing practice staff besides GPs, evaluating new types of appointment such as telephone consultations, and considering alternatives to general practice such as pharmacist- led minor illness services.
Lead author Thomas Cowling, National Institute for Health Research doctoral research fellow at the School of Public Health at Imperial College London, said: "Both parties have made bold promises about access to GP services, but the evidence behind their pledges is lacking.
"It's important that policies like extended access are independently evaluated before being implemented more widely.
"The pledges on increases to the GP workforce are very ambitious and unlikely to be met within a parliamentary term.
"The NHS should follow research evaluating new types of appointment that have been proposed to increase GP capacity, such as consultations and triage by phone or online. It should also consider other types of staff who could take on some of the work of GPs.
"I also suggest looking at ways to reduce demand for GP services, like providing pharmacist-led minor illness services, and investing in public health programmes that could reduce primary care demand in the long run through improving the population's health, which is the most important thing."