GPs' booking target system catches Blair out

29 April 2005
PM confused by a problem he was said to be concerned about six months ago


Tony Blair appeared baffled when confronted by an angry mother complaining she could not book advance appointments with her GP because of government targets.

Diana Church complained she had trouble making an appointment for her son because her local GP did not let patients book more than 48 hours in advance.

The only alternative was to queue outside the surgery or spend hours on the phone trying to get through to make an appointment within the next two days, she told Mr Blair on the BBC Question Time election special,

Mr Blair appeared bemused by the scenario and said he would be "absolutely astonished" if that was how GPs were behaving.

"That's news to me, that doctors are insisting that you have to come within the 48 hours. The whole purpose of this was that people used not to be able to get an appointment within 48 hours. Obviously, it shouldn't work that way, because it would be absurd," he said.

In fact the phenomenon has been recognised for some time as an unintended consequence of government targets designed to ensure everyone who wants to is able to see a GP quickly.

And it was causing concern to the Prime Minister as least six months ago, according to one of the Department of Health's senior officials.

Comments by Gary Belfield, DoH head of primary care at a conference organised by the primary care organisation the NHS Alliance, were reported in the medical trade magazine Pulse.

He said: "There is a big issue coming round the corner of restrictive booking, which is against the spirit of the target, so we are doing work with people on that.

"The Secretary of State and Prime Minister again are interested in that. It's a big London issue."

Two-day target
The problem has arisen as a result of the NHS plan in 2000, which originally set the 48-hour target.

The plan said: "All patients should be seen by a GP within two working days or a primary care professional within one working day if they wish to do so. Equally, patients may wish to be seen at a time more convenient to them outside the targets timescales, or to wait longer to see their preferred GP or health professional, and appointment systems should allow them to do so.

The target is one of the Government's key priorities - GP practices get payments if they meet it, and their progress is monitored by strategic health authorities.

GPs' representatives on the British Medical Association say a shortage of GPs means practices are under pressure to meet demand for appointments so a requirement to see more patients within 24 hours inevitably means there will be less space for longer-term pre-booked appointments.

And the problem of GPs restricting advanced booking had been officially noticed last summer, when Pulse reported the Department of Health had sent a memo to strategic health authorities stating that the practice was "not acceptable".

Unintended effects
The NHS Alliance and Royal College of GPs released a report in September last year calling for a re-think of the 48-hour target because of its unintended effects.

A summary of their report said: "Under the terms of the new contract GPs receive points for working to the 48-hour system. As a result many surgeries no longer accept advance appointments."

Mr Belfield made his comments to the NHS Alliance conference the next month. And in February this year, the Commons Health Select Committee announced an investigation to find out the extent of the problem and ask the Department of Health what it was doing to address it.

Asked why the Prime Minister appeared not to know about it yesterday, Health Secretary John Reid said it was his own job to know about such things.

He later released a statement saying the Government had made it clear in two leaflets that preventing pre-booking was against what the Government wanted doctors to do and advising on how to provide advance booking as well as quick appointments.

Mr Reid earlier said there were far fewer complaints about restrictive booking than there were about waits of more than a week to see a GP, which he said was the situation when Labour came to power.

Since November 2004 the Department of Health has included a question about restricted bookings in its regular survey of GPs. The results showed that of the 9,000-odd GP practices, advance booking was not offered at 12.4 per cent last November. This fell to 7.7 per cent in December, 3.6 per cent in March, and a provisional figure of 1.6 per cent in April.

The independent health think-tank the King's Fund has pointed out these figures cover only GP surgeries that offer no appointments bookable 48-hours in advance booking. They do not cover other surgeries that may offer some advance booking but cannot meet the demand for it from patients.

Sources
Pulse magazine, 25 October 2004, 9 August 2004, 12 February 2005
Patients before Planners, NHS Alliance press release, 23 September 2004
Definition of the 24/48 hour target, Department of Health Question Time, 28 April 2005


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