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Stocktake of access to general practice in England

People’s experience of accessing general practice remains positive, with almost 9 in 10 patients reporting in 2014-15 that they could get an appointment. Patient satisfaction with access is, however, gradually and consistently declining, and a fifth of patients report opening hours are not convenient, according to today’s report from the National Audit Office.

Worsening access to general practice matters: if patients cannot access general practice they are more likely to suffer poorer health outcomes or to use other, more expensive, NHS services such as accident and emergency departments.

The NAO found that there is considerable variation in access between different patient groups: older patients were more likely than younger patients to report that they were able to access appointments. The NAO also found that people from a white ethnic background reported better access than those from other ethnic groups. Differences in GP practices’ working arrangements also affect the proportion of patients who can get appointments.

Nationally, 92% of people live within 2 kilometres of a GP surgery, but there are stark differences between urban and rural areas. Only 1% of people in urban areas do not have a GP surgery within 2 kilometres, compared with 37% in rural areas.

Demand for general practice is increasing as the population grows and people live longer, often with multiple medical conditions. However, the Department of Health and NHS England do not have up-to-date data to estimate the number of consultations. The organisations that the NAO spoke to considered that general practice is under increasing pressure, with demand rising by more than capacity.

The NAO identified that problems in recruiting and retaining GPs are increasing, with 12% of training places in 2014/15 remaining unfilled. GPs make up only 29% of the general practice workforce, so alone are unlikely to be able to deal with the rising demand for services. Practices are increasingly using other staff to help manage demand.

Today’s report finds that deprived areas tend to have a lower ratio of GPs and nurses to patients, and where the ratio is lower it is harder for patients to get appointments. The distribution of general practice staff across the country does not reflect need. NHS England allocates funding to local areas using weighted populations that reflect factors such as demographics, health needs and local costs. Despite this, inequalities remain, with the combined number of GPs and nurses in each local area ranging from 63 to 114 per 100,000 weighted population.

Among the NAO’s recommendations are that NHS England should improve the data it collects on demand and supply in general practice, and research how different practices’ appointment-booking and other working arrangements drive variations in access. While making changes designed to improve access, NHS England should analyse the impact on different patient groups.

“Against the background of increasing demand and pressure on NHS resources, the challenge is how to maintain people’s positive experience of accessing general practice and reduce variation. The Department of Health and NHS England are working to improve access, but are making decisions without fully understanding either the demand for services or the capacity of the current system.Better data is needed so that decisions about how to use limited resources to best effect are well-informed.”

Amyas Morse, head of the National Audit Office

Notes for Editors

Funding for general practice in 2014-15

An estimate of the number of general practice consultations in 2014-15

Of patients in 2014-15 said they could get an appointment when they last tried to book one

GP practices in England in 2014, with 125,300 full-time equivalent staff

Full-time equivalent GPs (including trainee GPs) at September 2014

Hours Average number of hours GP practices are open per week

Of patients live within 2 kilometres of a GP surgery

63 to 114
Range in the number of GPs and nurses per 100,000 people, after adjusting for factors such as age and need

Of general practice training places were unfilled in 2014/15

Of patients in 2014-15 said it was not easy to get through to the GP practice on the telephone

1. Improving access to general practice is a priority for the government. It has committed to ensuring that people have access from 8am to 8pm, 7 days per week by 2020. It has also committed to recruiting 5,000 extra doctors to work in general practice.
2. Press notices and reports are available from the date of publication on the NAO website. Hard copies can be obtained by using the relevant links on our website.
3. The National Audit Office scrutinises public spending for Parliament and is independent of government. The Comptroller and Auditor General (C&AG), Sir Amyas Morse KCB, is an Officer of the House of Commons and leads the NAO, which employs some 810 people. The C&AG certifies the accounts of all government departments and many other public sector bodies. He has statutory authority to examine and report to Parliament on whether departments and the bodies they fund have used their resources efficiently, effectively, and with economy. Our studies evaluate the value for money of public spending, nationally and locally. Our recommendations and reports on good practice help government improve public services, and our work led to audited savings of £1.15 billion in 2014.

PN: 62/15