Month: January 2018

Seven-day access to NHS primary care: how does England compare with other European countries?

It is often assumed that providing easier access to community-based general practice during evenings and weekends can reduce demand for emergency and other unscheduled care services, promoting more appropriate care and reducing the costs associated with expensive hospital-based treatment. For example, in England’s NHS there is political pressure to expand general practice surgeries’ opening hours to progress towards a ‘seven-day NHS’.

When considering extension of primary care opening hours in England, it is useful to compare primary care access across other countries in the European Union. Despite differences in healthcare commissioning and funding, European countries face comparable challenges such as ageing populations and increases in chronic conditions and mental health problems, all of particular relevance to primary care.  In a paper published in the Journal of the Royal Society of Medicine, we examined England’s current in-hours general practice services relative to those of European countries in order to better contextualise the debate on extending general practice opening hours.

We found that standard opening hours in England already exceed those of most other European countries, and patients in the UK are more satisfied with out-of-hours access to general practice than patients in many other European countries. Achieving easier access to primary care services seven days per week would require significant investment, and must compete with other NHS priorities; politically attractive priorities should not to have an undue influence in shaping resource allocation.

The existence of true patient demand for extension of general practice opening hours in England is not yet fully established and evidence for a correlation between increasing in-hours provision and decreased emergency department use is inconclusive. Furthermore, the demand for services likely varies based on local demographics and disease burden; if general practice opening hours were to be extended, those regions with the highest demand for care should be prioritised.

Hence, we suggest that policy-makers in England should focus on improving access to GP appointments during normal opening hours, instead of spending scarce NHS resources on very poor value for money extended opening hours schemes.

Extending GP opening hours will not ease the rising burden on A&E departments

A study published in the journal BMJ Quality and Safety concluded that extending GP opening hours will not ease the rising burden on Accident and Emergency departments. The observational study was led by Imperial College London. Lead author Dr Thomas Cowling from Imperial College’s Department of Primary Care and Public Health and colleagues compared patients’ experiences of GP surgeries with the number of Accident and Emergency visits in their areas in England from 2011-2012 to 2013-2014. They examined reports from NHS England’s annual GP Patient Survey, and included patients registered to 8,124 GP surgeries.

We measured levels of patient satisfaction using three factors: the ease of making an appointment, opening hours, and overall experience. They then matched these responses with A&E departments in their area to observe any correlation with the number of visits to A&E. Overall, areas where patients were happier with the ease of making appointments, which could be for example by using online booking systems, saw slightly fewer visits to Accident and Emergency departments. However, satisfaction with surgery opening hours and overall patient experience seemed to have no impact on Accident and Emergency visit rates.

The study suggests that better satisfaction with GP hours, for example because of extended opening hours, does not affect the number of visits made to A&E in their geographical area. However, making the appointment booking process easier for patients was associated with slightly fewer Accident and Emergency visits in that area. Our research supports finding alternative options for easing the burden on Accident and Emergency departments, and casts doubt on the Government’s proposals to extend GP surgery hours to ease the burden on Accident and Emergency departments.

We measured satisfaction with hours without linking explicitly them to daytime weekday or evening and weekend appointment availability. We hypothesised that although weekend and evening appointments are convenient for healthy, working aged adults, those who are likely to need medical attention more urgently are older people or those who are chronically ill and not currently working full time.

Senior author Professor Azeem Majeed from Imperial’s School of Public health, who is a practising GP, said: “The government must find alternative ways to handle current pressures on Accident and Emergency departments. This could include for example improving access to GP appointments during normal opening hours rather than spending scarce NHS resources on extended opening schemes.”

Dr Cowling, also from Imperial’s School of Public Health, said: “It makes sense to think that extending GP hours will ease the burden on other NHS services, but our study suggests this might not be the case with Accident and Emergency.”

The study was reported in a number of media outlets including the TimesBelfast TelegraphOnMedicaPulse and Eureka Alert.

Interested in our Integrated Clinical Apprenticeship? Read our FAQs


Your Thursday morning and afternoon throughout your year 5 will be dedicated to the Integrated Clinical Apprenticeship. This has been negotiated with the Year 5 course leads and your Specialty supervisors for each firm. Attendance is mandatory for both morning and afternoon sessions. You will attend your allocated GP surgery on a time negotiated with your GP mentor. In the morning, you will see patients from your caseload, assessing their clinical needs and bringing yourself up to date with their secondary care contacts. You can then plan with your patient to attend any secondary care appointments in the coming weeks with your patients.  You may also see “ad hoc” patients from the surgery and, if relevant, add them to your caseload. There will be an opportunity to see other health professionals in the primary care team and assist in their daily activities.


This is a group of about 12 patients (shared with your pair), recruited by your GP and you, who you will follow through the year, both in primary and secondary care. Depending on their clinical condition, you may not be required to follow them through the entire year, but other patients can be “picked up” through the year on an ad-hoc basis.


You will be expected to see patients, assess them clinically, perform reviews (eg mental health and ante-natal reviews), manage your own appointments and home visits and perform investigations on your patients as required.


It will be up to you to decide whether some of the secondary care appointments will take precedence over commitments elsewhere in your firm. This will require discussion with your site leads as these arise. These negotiations are an important part of becoming a flexible clinician, requiring prioritisation and organisational skills.


Tutorials based in Imperial Campuses will start at 2pm and run until 5pm every Thursday. These will give you an opportunity to debrief with peers and course leads, present interesting cases (both from Integrated Clinical Apprenticeship and your firms) and receive tutorials based around course themes, relevant to the Year 5 core specialties.


There are no formal assessments in the Integrated Clinical Apprenticeship. However, there are some exercises during the year that are designed to help you reflect on your Year 5 learning with regard to your Integrated Clinical Apprenticeship work.


You first priority in this instance is to your patients and your surgery. Please let them know as soon as possible that you cannot attend so that they can inform your booked patients. Please also email the course administrator Noosheen Bashir ( You should always notify us prior to being absent from a session so that our records are accurate.

Research Outputs of England’s Hospital Episode Statistics Database

Hospital administrative data, such as those provided by the Hospital Episode Statistics (HES) database in England, are increasingly being used for research and quality improvement. To date, no study has tried to quantify and examine trends in the use of HES for research purposes. We therefore examined trends in the use of HES data for research. Our study was published in the Journal of Innovation in Health Informatics.

Publications generated from the use of HES data were extracted from PubMed and analysed. Publications from 1996 to 2014 were then examined further in the Science Citation Index (SCI) of the Thompson Scientific Institute for Science Information (Web of Science) for details of research specialty area. 520 studies, categorised into 44 specialty areas, were extracted from PubMed. The review showed an increase in publications over the 18-year period with an average of 27 publications per year, however with the majority of outputs observed in the latter part of the study period. The highest number of publications was in the Health Statistics specialty area.

We concluded that the use of HES data for research is becoming more common. Increase in publications over time shows that researchers are beginning to take advantage of the potential of HES data. Although HES is a valuable database, concerns exist over the accuracy and completeness of the data entered.