BMJ 2015;350:h1878 doi: 10.1136/bmj.h1878 (Published 8 April 2015)

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Election watch: access to GP services After five years of austerity the NHS has become a far greater battleground in this election than in the previous one. In the first of a weekly column in the run up to polling day on 7 May, Gareth Iacobucci looks at the issue that dominated the debate this week Gareth Iacobucci news reporter, The BMJ The issue of access to general practice took centre stage this week, as Labour attacked the Conservatives by claiming that almost 600 fewer GP surgeries in England are open in the evening and at weekends than before the coalition came to power in 2010.1 To illustrate its point, Labour launched an election poster that reinterpreted the Tories’ 1979 “Labour isn’t working” poster.

it easier for people to see their GP from 8 am to 8 pm, seven days a week, which was piloted from April 2014.6

The Tories have since committed £400m (€548m; $595m) to implement the policy nationally by 2020 and kicked off their election campaign by extending the pledge to include access to hospital diagnostic services and consultant clinics.7

Although the scheme’s impact has not yet been assessed, the Tories’ claim that more surgeries will be opening outside normal opening hours as a result of the policy is credible. However, a recent analysis in The BMJ argued that this and other political pledges designed to improve access to general practice were often pursued without enough evidence of their effectiveness.8 The analysis by Cowling and colleagues was critical of the Tories’ decision to roll out seven day, 8 am to 8 pm opening of general practices nationally before the results of an independent evaluation of the pilot were published.

The Tories hit back by saying that Labour’s figures were out of date and didn’t reflect the fact that general practice cover outside normal daytime hours was now being extended. Labour’s figures were obtained through a parliamentary question that showed that 72% of GPs took part in the extended hours scheme in 2013-14.2 This compared with 77% in July 2009,3 which Labour said represented a reduction of 590 surgeries. The figures do seem to support Labour’s assertion that the number of GPs offering extended opening hours did fall during the period 2009 to 2014. The reduction may be attributable to the coalition deciding, when it took office in 2010, to stop monitoring Labour’s previous target for at least 50% of GP surgeries to offer extended opening4 and by cutting funding attached to it by a third.5 But the Tories are justified in highlighting that Labour’s figures pre-date the effect of the Challenge Fund, a new scheme to make

For more from The BMJ on the UK general election go to 1 2 3 4

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BBC. Election 2015: Parties row over GP out-of-hours cover. 7 Apr 2015. uk/news/election-2015-32198148. Health and Social Care Information Centre. NHS Payments to General Practice, England, 2013-14. Feb 2015. Department of Health. Guidance: GP extended hours access. 30 Mar 2010. http:// dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_114933.pdf. Department of Health. Revision to the operating framework for the NHS in England 2010/11. 21 Jun 2010. // digitalasset/dh_116860.pdf. Nowottny S. Extended hours funding cut by a third. 11 Mar 2011. extended-hours-funding-cut-by-a-third/11055136.article#.VSOse_nF_LI. Iacobucci G. Cameron announces plan for seven day access to GPs. 1 Oct 2013. BMJ 2013;347:f5949. BBC. Election 2015: Cameron promises “seven-day NHS” by 2020. 28 Mar 2015. www. Cowling T, Harris M, Majeed A. Evidence and rhetoric about access to UK primary care. 31 Mar 2015. BMJ 2015;350:h1513.

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