2Reducing variation
16.There is large variation in general practice staffing between local areas. Once the population is adjusted to account for patient needs, the number of GPs and nurses per 100,000 people in each clinical commissioning group ranged from 114 in Sheffield to 63 in Swale in 2014. The most deprived areas tend to have the fewest GPs and nurses per 100,000 people.30 The Royal College of General Practitioners said that, while some GPs explicitly chose to work in deprived areas, there had been no mechanisms to distribute the GP workforce fairly across the country and no ways of supporting general practice staff working in areas of greatest deprivation.31 In addition, a higher proportion of older GPs work in urban and deprived areas which raises the risk that the inequality between areas may increase when these GPs come to retire.32 NHS England highlighted that the retirement in the coming years of GPs recruited in the 1960s and 1970s, including from South Asia, would leave a gap in areas such as Birmingham, Leicester and parts of the North East and North West. It also told us that it was much easier to fill GP training places in London than in other areas such as the East Midlands and the North East.33
17.Inequalities in the distribution of general practice staff have reduced in recent years—in 2010, the most deprived areas had on average 19.2 fewer GPs and nurses per 100,000 people than the least deprived. By 2014, this gap had narrowed to 4.9 GPs and nurses.34 NHS England told us that this change reflected improved equity in funding allocations and the targeting of extra funding for primary care at areas that were short of staff. The workforce action plan includes measures to attract new doctors to areas of greatest need, for example by offering financial incentives.35
18.The Royal College of General Practitioners highlighted that the distribution of general practice staff has an impact on health inequalities.36 The National Audit Office reported that in areas where there were fewer staff it was harder for patients to get appointments. In the third of clinical commissioning groups with the lowest ratio of GPs and nurses to patients, 13% of patients could not get an appointment, compared with 10% in the third of clinical commissioning groups with the highest ratio.37
19.The GP Patient Survey shows that the experiences of different groups of patients very significantly. In essence, patients who are older, white or in a more affluent urban area get better access than others. In contrast, younger patients and those from minority ethnic groups are more likely to report difficulties in getting and making an appointment or in seeing their preferred member of staff. For example, in 2014–15 19% of Asian patients were unable to get an appointment, compared with 11% of white patients.38 Those patients that are working full-time are most likely to be dissatisfied. Older people, and those with long-term conditions, tend to value continuity of care, while those people of working age who are generally well tend to be more concerned to get an appointment quickly when they do fall ill. NHS England told us that it needs to provide a more differentiated offer in general practice to better meet the expectations of different patient groups.39
20.There is also considerable variation between different practices. The National Audit Office found that in 2014–15 the proportion of patients unable to get an appointment ranged from 0% to 52%. Most of the variation appeared to come from the way in which the practices were managed, as only a quarter of the difference could be explained by patient demographics, the size of the practice or staffing.40 NHS England said that it sought to ensure that, when practices identified something which worked well, they shared this more widely, but it acknowledged it was not as easy as it should be for general practices to find out what was working well elsewhere in the country.41
21.The Department and NHS England told us about the work of the Prime Minister’s GP Access Fund which has been piloting ways of improving access. These pilots are trialling extended opening hours in the evenings and weekends, better use of technology, telephone consultations, and using a wider mix of staff, with the aim of providing better access.42 NHS England said it had run a series of webinars to share learning from the first wave of pilots, and had buddied practices that have tried these new approaches with others that are looking to adopt them. It also said that, although there were some national initiatives, there could be no ‘one size fits all’ approach to improving access in general practice.43 It said that providing access from 8am to 8pm, 7 days a week in every general practice was not feasible and had not been mandated by the Department.44
22.The National Audit Office report highlighted that research had found that 27% of GP consultations were potentially avoidable, including patients who could have been seen by others in the practice or by pharmacists.45 Healthwatch England told us that the patients they had spoken to did not mind whether they saw a GP, a nurse, a physiotherapist, or another professional when it was the right thing to do. It also said that patients were positive about the developing role of pharmacists.46 NHS England said it was developing a new voluntary contract for GPs from April 2017 for those practices that wanted to bring together a wide range of services rather than just the core traditional general practice.47
23.The public need information about general practices to help them choose which practice they would like to register with, and to know how and when they can get appointments. The amount of information provided to the public varies between practices. For example, Healthwatch Slough found that five of the sixteen GP practices in the local area had good information, but three practices had no website.48 The Royal College of General Practitioners said that it was good practice to have a website but this may not be a priority for all practices.49
24.We also asked Healthwatch England about other concerns that local Healthwatch organisations had raised, including difficulties in dealing with receptionists and in getting through on the telephone.50 For example, a Healthwatch England report in 2015 found that in one county, more than a quarter of practices gave the wrong telephone number for out-of-hours GP services.51 The Royal College of General Practitioners confirmed that providing information about where to go for assistance when the practice is closed was an important patient safety requirement. Healthwatch England said that some practices were better than others at taking this requirement seriously.52
25.We asked whether good websites and information could save the time of GPs and reduce the number of unnecessary appointments. Research by Citizens Advice in 2015 estimated that almost one-fifth of GPs’ consultation time was spent discussing matters such as welfare, debt and personal relationships. The Royal College of General Practitioners told us that it would be helpful if patients could find out how to access other services such as dieticians, counsellors, benefits and housing advice without having to go through their general practice.53
© Parliamentary copyright 2015
Prepared 3 March 2016