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Seven-day GP services blow with 'very low' Sunday demand

The Prime Minister's plans to deliver seven-day GP services have been dealt a blow after an official review found there was "very low" demand for Sunday appointments.

Patients also snubbed appointments on Saturday afternoons, although Saturday mornings and weekday evenings proved more popular.

The review examined data from 20 pilot sites across England - covering 1,100 general practices and 7.5 million patients - that have been testing seven-day services.

It comes after David Cameron pledged a "truly seven-day NHS" for patients in accessing GPs, a plan that was described by Downing Street earlier this month as "groundbreaking".

The new report, from independent consultancy firm Mott MacDonald, found there has been some success with the scheme, including better use of weekday GP time.

But it said there had been low up-take of weekend appointments compared with weekday ones, particularly on Sundays.

As a result, some sites have cut their weekend appointments to just a few hours, while others have ceased to offer any extended hours appointments.

The report said: "This pattern of low demand on Sundays has been evident nationwide.

"There are exceptions (for example, Bury, Morecambe and South Kent Coast do not report any utilisation problems at weekends) but the vast majority of pilots have highlighted this in their feedback.

"Often these pilots are reporting that low take-up on Sundays and some (although far fewer) also highlighting low demand on Saturday afternoons and evenings.

"For example, across Darlington, local analysis of its pre-bookable appointments between October 2014 and March 2015 identified that on a Saturday 54% of appointments were booked compared to 12% on a Sunday.

"As a result of Sunday trends, many pilots have begun reducing their weekend service offer to fewer hours, with some ceasing provision on Sundays completely (Watford, Hambleton, Richmondshire and Whitby , Darlington) or are monitoring the situation with a view to potential discontinuation (BHR, Brighton and Hove, Warrington)."

The report said there is "general agreement" that the lack of success with weekend extended hours is not down to how services are communicated to patients, but " rather it is a result of entrenched patient behaviours."

The report said that the "average utilisation" of available appointments during normal core working hours was 94%, dropping to 75% during extended working hours.

It concluded: "Given reported low utilisation on Sundays in most locations, additional hours are most likely to be well utilised if provided during the week or on Saturdays (particularly Saturday mornings).

"Furthermore, where pilots do choose to make some appointment hours available at the weekend, evidence to date suggests that these might best be reserved for urgent care rather than pre-bookable slots."

Video appointments with GPs also did not "prove popular" with patients in some areas, while doctors in some regions were reluctant to offer more phone consultations, preferring to see patients face-to-face.

The Royal College of GPs said the findings came as no surprise and patients "have better things to do on a Sunday afternoon than have their ears syringed".

Overall, the report said that "whereas weekday slots have been well-utilised, patient demand for routine appointments on Sundays has been very low".

Birmingham has "concluded that their most effective delivery model lies not exclusively in providing additional hours, but in using core hours more effectively".

Meanwhile, in Hambleton, Richmondshire and Whitby, extended hours have been stopped altogether following to low demand from patients.

Dr Chaand Nagpaul, chair of the British Medical Association's GP committee, said the report raised " serious concerns" about the value and expense of the Government's "inflexible approach" to seven-day services.

He said: "There was extremely poor demand from patients for appointments on Sundays, and in many cases on Saturday afternoons, resulting in precious NHS resources being wasted on keeping near-empty practices open and staffed.

"The cost of providing care during these hours was significantly higher than routine GP practice appointments during the week.

"While some areas showed a slight decrease in minor illness attendances at A&E, there was no reduction in hospital admissions, and any cost saving would need to be balanced by the considerable expense of running these pilots."

The report said video and e-consultations had been met with a "mixed reception from both GPs and patients" and had " yet to prove any significant benefits".

The pilot sites also experienced some "capacity issues" in recruiting GPs to work, or had to compete with out of hours providers for GP time.

But the study did say there had been achievements, including 4.9 million patients having access to new or enhanced appointment services during the week.

There was also a 15% reduction in A&E attendances for minor illnesses across the pilot schemes.

Overall, £150 million has been pledged by the Government for the Prime Minister's Challenge Fund to improve access to GP services.

Dr Maureen Baker, chair of the Royal College of GPs, said the money had provided welcome funding for GPs but added: "It will come as no surprise to dedicated and hardworking GPs that schemes to extend access have not been as popular as the Government predicted.

"It might sounds like a good idea in principle, but our patients realise that this isn't the best use of precious NHS funds - and they have better things to do on a Sunday afternoon than have their ears syringed.

"Access to GP services is extremely important but prioritising weekend and evening access must not come at the expense of services during normal hours so that patients end up worse off.

"We hope that this evaluation will spur the Government away from its obsession with a seven-day service and towards ensuring that our existing routine family doctor service and GP out of hours services are more integrated and robust, so that our patients can see a GP when they really need one."

An NHS England spokesman said: "This evaluation shows that GPs and their teams are leading the drive for innovation, taking improvements far beyond increasing opening hours.

"They are providing patients with the right care, from the right professional, at a time which is convenient for them.

"We will consider the findings of this first evaluation as we take forward our commitment in the Five-Year Forward View to strengthen and support primary care."

A Department of Health spokeswoman said: "This study shows the success of the PM Challenge Fund - delivering 400,000 evening and weekend appointments and reducing minor A&E visits by 15%.

"By 2020 this approach will be rolled out across the country as part of our plan for a seven-day NHS.

"We know patients want access to GPs outside of working hours, and it is a shame that the RCGP and the BMA aren't celebrating the thousands of innovative doctors committed to ensuring patients can access healthcare when and where they need it."

The DoH spokeswoman added that it is recognised there is more to be done on promoting Sunday appointments but as this becomes "normalised", officials expect uptake to improve.


From Belfast Telegraph