David Cameron’s hopes of introducing seven-day GP services across England have been dealt a blow by the reluctance of patients to attend surgery on Sundays and Saturday afternoons.
The prime minster has promised to offer voluntary contracts to family doctors ready to offer through-the-week cover.
A review of 20 pilot schemes covering 1,100 practices and 7.5 million patients, supported by £50m in funds ordered by Cameron, indicates that while increased surgery hours during working days and Saturday mornings have proved popular, Sunday attendance was “very low”.
Some GPs have therefore already cut weekend appointments to just a few hours while others have already stopped them entirely.
An evaluation for NHS England by consultancy Mott MacDonald suggests weekend sessions in future might be better reserved for urgent care rather than pre-booked appointments.
More opportunities for patients to have phone consultations have proved popular, even if video and online consultations have not.
Increased use of nurses, pharmacists, paramedics and physiotherapists and better links with care homes and voluntary services have also freed GPs’ time, says the report.
But there has been a reluctance among GPs to take part in the pilots, with extended Friday evenings and weekend sessions being the most problematic. There is also a critical shortage of senior nurses, a problem that might have been made worse because the contracts on offer are short-term.
The extra cost of indemnity insurance for staff has been another problem, meaning services such as taking blood or syringing ears have been difficult to offer.
The report says: “As a result of Sunday trends, many pilots have begun reducing their weekend service offer to fewer hours, with some ceasing provision on Sundays completely or are monitoring the situation with a view to potential discontinuation.”
The report said there is “general agreement” that the lack of success with weekend extended hours is not down to how services are communicated to patients, but “rather it is a result of entrenched patient behaviours”.
NHS England said: “This evaluation shows that GPs and their teams are leading the drive for innovation, taking improvements far beyond increasing opening hours.
“They are providing patients with the right care, from the right professional, at a time which is convenient for them.
“We will consider the findings of this first evaluation as we take forward our commitment in the Five Year Forward View to strengthen and support primary care.”
The Royal College of GPs hoped the evaluation would spur the government to drop “its obsession with seven-day service”. Its chair Maureen Baker said: “It will come as no surprise to dedicated and hardworking GPs that schemes to extend access have not been as popular as the government predicted.
“It might sounds like a good idea in principle, but our patients realise that this isn’t the best use of precious NHS funds – and they have better things to do on a Sunday afternoon than have their ears syringed.”
Baker said: “The prime minister’s GP access fund has provided welcome funding to some GP practices – but family doctors must be free to tailor these resources to the needs of their local populations, in the best interests of their patients.
“Access to GP services is extremely important but prioritising weekend and evening access must not come at the expense of services during normal hours so that patients end up worse off.”
Dr Chaand Nagpaul, chair of the British Medical Association’s GP committee, said: “How we deliver further benefits to the public needs to addressed, but this independent evaluation … raises serious concerns about the value and expense of the government’s inflexible approach to seven day services for general practice.”
Poor demand from patients for appointments on Sundays, and in many cases on Saturday afternoons, had resulted in NHS resources being wasted on keeping near empty practices open and staffed, Nagpaul said.
“The cost of providing care during these hours was significantly higher than routine GP practice appointments during the week,” he said.
“While some areas showed a slight decrease in minor illness attendances at A&E, there was no reduction in hospital admissions, and any cost saving would need to be balanced by the considerable expense of running these pilots.
“At a time of extreme pressures on GP services, with many practices struggling to cope with patient demand and falling resources, the government needs to learn the lessons from its own pilots.”
The Department of Health recognised there was more to be done in promoting Sunday GP appointments but insisted attendance would improve as Sunday appointments became “normalised”.
Seven day GP services would be in place across England by 2020. “We know patients want access to GPs outside of working hours, and it is a shame that the RCGP and the BMA aren’t celebrating the thousands of innovative doctors committed to ensuring patients can access healthcare when and where they need it.”
