Yes: Laurence Buckman, GP and chairman of the BMA’s GPs Committee
How could anyone argue with better access for patients? On the face of it, this target would seem to many to be a way of ensuring this. However, even before its introduction, most GPs thought that the target would alter surgery behaviour for the worse and so it proved. We were already measuring what our patients thought of us — in official surveys handed out immediately after they left the surgery. It meant that we could respond quickly and easily to any concerns. For most GPs, providing good access for their patients is a matter of professional pride.
GPs warned that a target that did not allow them to prioritise appointments, but meant that they had to give away appointments to anyone who wanted them, would have adverse conse-quences. To meet the target, enough appointments had to be held open to ensure that all who wanted quick access to a GP could get it. We thought that this would result in forcing patients to phone in on the day to get an appointment, even though they would have to hang around to be seen and were not really urgent.
GPs have spent their entire careers juggling the demands of the sick, the slightly sick and the worried well but we were told to be universally available without limit. Anyone with wisdom would spot that there is only a finite time in which to make appointments available.
Unfortunately, as we predicted, patients have been inconvenienced and practices stressed by trying to square this impossible circle. The idea of advance booking, which is convenient for patients who need to see their GP regularly and therefore a part of good access, was virtually done away with on a politician’s whim.
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I would argue that patients should be seen within 48 minutes if they are sick, and certainly within that surgery session, whereas those who want a routine matter dealt with could reasonably be asked to wait, and those who have to go to work should have the first cut of the appointments at the end of the day — which means holding them for this purpose. If you are ill, then you should not be at work anyway, but if you fall ill at work, you should be able to get an appointment swiftly, and you should be able to plan your day around seeing a GP for a non-urgent matter without having to get in an urgent queue and missing time off work.
Getting rid of this target means that I am free to give my patients what they want and see these different groups of patients as the situation demands. I will know very quickly if patients are dissatisfied by the planning choices I make because my patients will do as they’ve always done and tell me. People who are sick will be seen much quicker, people who go to work will be seen at a time of their choosing and people who want reassurance about their health will be more able to get an appointment, though they might have to wait a bit longer. I will be able to prioritise the sickest first because that is my job, what I trained to do and what patients rightly expect, too.
No: Katherine Murphy, Director of the Patients Association
Some GPs across the country breathed a sigh of relief when the urgent appointment target was abolished. Some can now revert, or in some places continue, to be rigid in how many hours they will open their surgeries, how they will organise their appointments and how sensitive they will be to the needs of their patients.
Abolishing the urgent GP appointment target and others for hospital appointments before at least trying to take some steps to put in place something else to keep up the pressure was a mistake. The vast majority of GPs breathed a sigh of relief because they have been released from the shackles of being heavily performance managed on whether or not their patients were able to get urgent appointments irrespective of whether they needed one clinically. They will now try to decide when to see their patients based on clinical need.
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For all its complexities, healthcare is just like any other business or organisation. It is staffed by ordinary people. And among a large group of people, even one as highly educated and professional as doctors, there will always be some rotten apples in the barrel and, perhaps more important, quite a few that have lost their shine.
The NHS needs a system of performance management that gives freedom to the very best staff while ensuring that those patients unlucky enough to be getting their care from a less enthusiastic or less competent member of the workforce do not get second-rate treatment.
We must continue the mindset of the old targets, being very rigorous and demanding of services and staff, but using sophisticated and wide-ranging measures to do this so that the very best are not shackled, but that the very worst still feel the pressure.
Before the abolition of the target, GPs lost income if they performed badly in their practice surveys asking patients whether they could get an urgent appointment. This week we should have transferred the income attached to doing well from this question to doing well on the question asking patients whether overall they thought the quality of care they received was good. This would have sent a clear message to those who needed to hear it that it won’t be a free-for-all on the quality of the service — at least until we get a fully comprehensive system up and running. Quite bafflingly, it continues to make no difference to GPs’ income if they do poorly on the quality question.
This year we were also due to see the start of revalidation that hopefully would have involved the more rigorous collection of patient feedback on individual doctors. This is a fantastic way of sorting the wheat from the chaff, but implementation has been delayed — another lost opportunity.
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It is clear the new Health Secretary is committed to dismantling the unsophisticated targets regime and focusing rightly on outcomes and experiences for patients, but we cannot hesitate on implementation. Patients will suffer if we do.