Report published 27 April 2017. Government response published 12 October 2017.
Report and response published
Scope of the inquiry
A recently published National Audit Office investigation has found that the Department of Health and NHS England do have a high-level vision for improving patient access to general practice and have increased the funding available, but are seeking to extend access despite failing to provide consistent value for money from existing services. The Department has set objectives such as providing evening and weekend access for all patients and 5,000 extra doctors in general practice, both by 2020. However, they have not evaluated the cost-effectiveness and consequences of their objectives. The NAO's analysis suggests the minimum additional capacity required by the new commitment equates to £230 per appointment hour per 1,000 registered patients. In core contract hours the cost is an estimated £154. NHS England intends that the additional funding will be used to also cover transformation costs and deliver wider improvements in access, but has not currently set out how it will take assurance that the additional funding provides good value for money.
The most commonly used contract is the General Medical Services contract, which stipulates that "core hours" are 8 am to 6.30 pm, Monday to Friday. Practices do not necessarily have to be open throughout these core hours, but they must provide essential services at times to meet the reasonable needs of their patients. The NAO found variations in practices' opening hours during these times. As at October 2015, some 46% of practices closed at some point during core hours. In particular, 18% closed at or before 3 pm on at least one weekday, although three-quarters (76%) of those practices that closed received additional funding in 2015–16 to provide access outside of core hours. Shorter opening hours are associated with poorer outcomes.
The NAO report found that NHS England and Health Education England’s efforts to increase the GP workforce are at particular risk from falling retention, shortfalls in recruitment and increases in part-time working. The time taken to train clinical staff, and increasing demand, mean supplying sufficient numbers is challenging. Against a target of 3,250 GP training places in 2016–17, Health Education England only filled 3,019 (93%) places, although this was an increase from 2,769 in 2015–16. NHS England is supporting general practice to employ a wider staff mix but the incentives for practices to employ staff cost-effectively are not yet aligned.