The recent appointment of Matt Hancock as the new Health Secretary took many by surprise – few people can claim to have seen the selection of the former digital minister coming. Given his former roles as Secretary of State for Digital, Culture, Media and Sport and Minister of State for Digital and Culture, it’s unsurprising that his focus on GP apps has grabbed the headlines. While digital transformation is clearly high on his agenda, the West Suffolk MP has inherited a number of big issues that need sorting, not least opening hours and GP access.

The introduction of seven-day and evening routine GP appointments was the flagship policy of his predecessor – and Hancock inherits a mixed bag of sentiment towards the idea.

On the one hand, there’s a promise that funding for extended access to routine GP appointments is set to rise – from the current £3.34 per patient to £6 per patient in 2019/20 – and the latest figures from NHS England show that some 40% of patients could make routine GP appointments in evenings and at weekends in March. That figure is likely to be higher today, given the fact that CCGs up and down the country started an extended hour push in April.

Yet, there has been criticism of the plans, with the Public Accounts Committee continuing to warn that the proposals could prove expensive and duplicate existing out-of-hours services. What’s more, the NHS England survey of 6,892 GP practices found that 805 practices, with a combined 5.4 million patients, did not offer any extended hours provision when the latest data were collected in March.

This was down from 826 practices at the latest count, in September 2017. This data comes as NHS England planning guidance requires CCGs to provide ‘extended access to GP services, including at evenings and weekends, for 100% of their population by 1 October 2018’. There’s clearly still work to do.

Missing the point

The debate about extended hours will no doubt continue to rumble on. However, in many people’s opinion, to debate whether a practice opens on Sundays or not – and impose a blanket policy – is missing the point somewhat. Instead, they argue, the debate should be about patient access.

Helpfully, this subject was recently touched on in an updated CQC mythbuster, written by Nigel Sparrow, Senior National GP Advisor and Responsible Officer at the CQC. Rather than focusing on extended hours, the document highlighted contractual agreements and delivering service to patients within and around core hours – something CQC inspectors will be looking at when they call.

Inspections and patient access

When inspectors visit a GP practice they consider whether it is responsive to people’s needs. A KLOE is to discover:

• Can people access care and treatment in a timely way?
• Do people have timely access to appointments for an initial assessment, for diagnosis and for treatment or ongoing management of chronic conditions
• Is the appointments system easy to use and does it support people to access appointments?
• Can people access care and treatment at a time to suit them?
• Does the service prioritise people with the most urgent needs, including through triage?
• Do services run on time, and are people kept informed about disruption?

To be considered ‘good’ the inspectors expect to see evidence that:

• people can access the right care at the right time
• access to appointments is managed to take account of people’s needs, including those with urgent needs
• waiting times, delays and cancellations should be minimal and managed appropriately
• services should run on time and people kept informed of any disruption to their care or treatment.

And this is surely the point most practice managers will hope the new health secretary will take on board, unlike his predecessor – the holy grail for patient access isn’t always about evenings and weekends. It’s about each practice list’s needs and wants, whatever and whenever that may be.

Core hours

On the flip side, the mythbuster focuses on opening during core hours. Nigel writes: “On our inspections, where practices are not open during all of the core hours yet we find evidence that patients can continue to access appointments and services (both when the practice is open and when it is closed), then being closed for some part of the core hours will not lead to a poor rating for responsiveness. The important issue we consider is whether patients can access the care they need.

“If there is evidence that people are frequently and consistently unable to access appointments and services in a timely way, or experience unacceptable waits for some appointments and services,

we are likely to judge a GP practice as being inadequate for responsive. This may apply where a practice is open during all of the core hours as well as cases where the practice is closed for some of the core hours. In these cases, we would expect to see a development plan to improve access.”

“If a GP practice is closed during its core hours and does not make arrangements for patients to access care, should they need it, we will consider this to be poor practice, which potentially puts patients at risk. This will be considered as part of their rating.”

The mythbuster concludes by saying: “The important point we consider in inspections is the impact on people who are using the GP practice and whether they are able to access appointments and services when they need them.”

Of course, as we all know, achieving this is about much more than simply extending opening hours and instead revolves around issues such as training, retaining and recruiting more GPs, reducing the burden of red tape and providing the resources necessary to deliver effective services. Matt Hancock, you’ve got your work cut out!

What do you think the new Health Secretary should focus on in his new role? Let us know by commenting below or take it to the Practice Index forum here.