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Why election pledges from politicians on NHS primary care need careful examination

The likely effects of the Conservatives' and Labour's pledges to improve access to primary care are unclear. Both main parties have promised large increases in the number of GPs and significant improvements in access to appointments. In an article published in the the British Medical Journal, Thomas Cowling and Matthew Harris and myself - from the Department of Primary Care and Public Health at Imperial College London - say the pledges are unlikely to be achieved within a single parliamentary term.

The Labour Party have pledged to recruit 8,000 new GPs and plan to reintroduce their guarantee of an appointment within 48 hours. This target was far from being achieved under the last Labour government, with only 81 per cent of patients able to see a GP within two weekdays in 2009-10. As well as recruiting 5,000 extra GPs, the Conservatives have promised that if they are re-elected, patients in England will be able to see a GP between 8am and 8pm, seven days a week. This policy has been piloted in 14 per cent of GP practices, but results of an independent evaluation are yet to be published.

Thomas Cowling, NIHR Doctoral Research Fellow in the School of Public Health at Imperial College London, said: "Both parties have made bold promises about access to GP services, but the evidence behind their pledges is lacking. It's important that policies like extended access are independently evaluated before being implemented more widely."

"The pledges on increases to the GP workforce are very ambitious and unlikely to be met within a parliamentary term. The NHS should follow research evaluating new types of appointment that have been proposed to increase GP capacity, such as consultations and triage by phone or online. It should also consider other types of staff who could take on some of the work of GPs."

"I also suggest looking at ways to reduce demand for GP services, like providing pharmacist-led minor illness services, and investing in public health programmes that could reduce primary care demand in the long run through improving the population's health, which is the most important thing."

The BMJ article discusses the aims of the parties' pledges and looks at the evidence for how effective they would be. The largest increase in the GP workforce over any previous five-year period was 5,414, from 2004 to 2009. Last year, a GP Taskforce report identified major recruitment and retention problems that need to be tackled to increase GP numbers, including a shortage of GP training posts.

Both Labour and the Conservatives claim that their policies will reduce attendance at A&E departments. Although some studies have found an association between GP access and lower rates of A&E visits and emergency admissions, there is a lack of evidence that improving access over time reduces the demand for other services.

Although both parties appear to see access to primary care as a serious problem, we point out that international comparisons typically rate the UK highly, such as a recent assessment of 11 high-income countries that ranked the UK top for access to healthcare. Approximately 90% of patients in England were able to get a general practice appointment on their last attempt to do so, according to national patient survey data.

We conclude the article with five points of action for policy and research:
  • Evaluate the existing pilot scheme of extended general practice opening hours
  • Make more data on the work done in primary care routinely available
  • Discuss the mix of staff in general practice
  • Evaluate new types of appointment (e.g. phone and online)
  • Give due consideration to increases in demand for general practice when designing policies
The article received widespread coverage in media outlets such as the Independent, Sky News, Yahoo, Daily Mail and Newsweek.

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