BMJ 2015;350:h1513 doi: 10.1136/bmj.h1513 (Published 1 April 2015)
Page 1 of 5
Analysis
ANALYSIS Evidence and rhetoric about access to UK primary care As the general election in the UK approaches and NHS policies are set to take centre stage, Thomas E Cowling, Matthew J Harris, and Azeem Majeed discuss the evidence, uncertainty, and debate behind access to primary care 1
Thomas E Cowling National Institute for Health Research doctoral research fellow , Matthew J 12 Harris Commonwealth Fund Harkness fellow in healthcare policy and practice , Azeem Majeed 1 professor of primary care Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK; 2Department of Nutrition, Food Studies, and Public Health, New York University, New York, USA 1
Access to general practice is a prominent issue in national policy debate ahead of the 2015 UK general election in May. The two main parties, Conservative and Labour, have both made bold pledges on this topic. However, the problem with access has not been precisely defined; nor has the evidence behind pledges been made clear. Below we discuss the evidence on problems with access and whether the party promises are likely to be achievable.
Party pledges
The prime minister has declared that everyone in England will be able to see a general practitioner between 8 am and 8 pm, seven days a week, by 2020 if the Conservative Party is re-elected to government.1 A £400m (€538m; $610m) commitment to implement the policy nationally follows a £50m pilot in about 14% (1147) of general practices.1 2 Results from independent evaluation of the pilot are yet to be published. The government also plans for an extra 5000 GPs and spending an additional £2bn on the frontline of the English NHS next year (currently there are 40 000 GPs and spending is £115bn).3 4
The Labour Party aims to guarantee a GP appointment within 48 hours—a policy recycled from past Labour governments.5 A pledge to invest an extra £100m in primary care a year was followed by the promise of a £2.5bn fund for use across the NHS.5 6 Labour also intends to recruit 8000 more GPs.6 The Liberal Democrats also plan to improve access to general practice (partly through longer opening hours),7 but their pledges are more reserved.
With each party striving for support, politicians have promoted increases in the supply of general practice, particularly numbers of GPs. Each party sees a problem with access that they intend to solve, we presume. But this problem has not been well characterised.
How much of a problem is access? Access is best assessed using data from the GP Patient Survey—a national survey of patients’ experiences of English general practices. The table⇓ gives results from the latest three data years.8 9
In 2013-14, 88.8% of patients reported being able to get an appointment last time they tried, and the appointment was convenient for 91.9% of them; 55.8% of patients had a preferred GP, 61% of whom reported seeing or speaking to this GP always, almost always, or a lot of the time. Each of these measures decreased slightly from 2011-12 to 2013-14 (all P
Page 1 of 5
Analysis
ANALYSIS Evidence and rhetoric about access to UK primary care As the general election in the UK approaches and NHS policies are set to take centre stage, Thomas E Cowling, Matthew J Harris, and Azeem Majeed discuss the evidence, uncertainty, and debate behind access to primary care 1
Thomas E Cowling National Institute for Health Research doctoral research fellow , Matthew J 12 Harris Commonwealth Fund Harkness fellow in healthcare policy and practice , Azeem Majeed 1 professor of primary care Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK; 2Department of Nutrition, Food Studies, and Public Health, New York University, New York, USA 1
Access to general practice is a prominent issue in national policy debate ahead of the 2015 UK general election in May. The two main parties, Conservative and Labour, have both made bold pledges on this topic. However, the problem with access has not been precisely defined; nor has the evidence behind pledges been made clear. Below we discuss the evidence on problems with access and whether the party promises are likely to be achievable.
Party pledges
The prime minister has declared that everyone in England will be able to see a general practitioner between 8 am and 8 pm, seven days a week, by 2020 if the Conservative Party is re-elected to government.1 A £400m (€538m; $610m) commitment to implement the policy nationally follows a £50m pilot in about 14% (1147) of general practices.1 2 Results from independent evaluation of the pilot are yet to be published. The government also plans for an extra 5000 GPs and spending an additional £2bn on the frontline of the English NHS next year (currently there are 40 000 GPs and spending is £115bn).3 4
The Labour Party aims to guarantee a GP appointment within 48 hours—a policy recycled from past Labour governments.5 A pledge to invest an extra £100m in primary care a year was followed by the promise of a £2.5bn fund for use across the NHS.5 6 Labour also intends to recruit 8000 more GPs.6 The Liberal Democrats also plan to improve access to general practice (partly through longer opening hours),7 but their pledges are more reserved.
With each party striving for support, politicians have promoted increases in the supply of general practice, particularly numbers of GPs. Each party sees a problem with access that they intend to solve, we presume. But this problem has not been well characterised.
How much of a problem is access? Access is best assessed using data from the GP Patient Survey—a national survey of patients’ experiences of English general practices. The table⇓ gives results from the latest three data years.8 9
In 2013-14, 88.8% of patients reported being able to get an appointment last time they tried, and the appointment was convenient for 91.9% of them; 55.8% of patients had a preferred GP, 61% of whom reported seeing or speaking to this GP always, almost always, or a lot of the time. Each of these measures decreased slightly from 2011-12 to 2013-14 (all P
