We have completely updated this information. It focuses on how patients need to be able to access services.
Like all health and care services, GP practices have a crucial role in supporting the health needs of their local communities and preventing ill health.
The COVID-19 pandemic changed the way in which people access GP services. There has been a rapid shift in the way that appointments take place with a move to telephone and online appointments.
The issue of access to GP services continues to receive national attention with concerns including decreasing levels of patient satisfaction and workforce challenges in the sector. Our State of Care 2021/22 report describes the challenges and impact this has on patients.
What is access?
The King's Fund Rapid view of access report describes what patients consider to be good access:
- Is it easy to get to and into the surgery?
- Can I get an appointment to see an appropriate person when I want it?
- Can I see who I want to see?
- Can I get a good-quality consultation with appropriate specialist referral if required?
- Do I have access to a good range of on-site services?
The report categorises access into 3 main areas:
- physical access
- timely access
1. Physical access
You need to consider:
- where your practice is located in relation to patients, transport links and other services
- accessibility of premises and facilities to support access to telephone systems
- digital services including online booking services
- home visits
Accessibility of appointments can also be affected by appropriate numbers of skilled staff.
There is no formula and we do not advise the ratio for the number of appointments a GP practice should offer. Different populations have differing care needs. So you need to consider staffing models, skill mixes and approaches that are appropriate for your local population.
Appointments are increasingly offered by a range of different professionals.
2. Timely access
Timely access can be affected by:
- types of appointments
- out-of-hours services
- waiting times
You should consider whether the type and proportion of appointments, and the skill mix of staff, meets the needs of the local population.
Patient choice may include the option for your patients to see a GP or other clinician or be signposted to access a range of services. Patients have the option to request a named GP or clinician, but this may delay access to care and treatment. You should make patients aware of this.
Clinicians should advise patients to re-book with the same member of staff for continuity of care. Although this may delay access, it would improve outcomes and bring other benefits for both the patient and clinician. Continuity of care provides the foundation for safe, efficient and coordinated care especially for those patients with complex and multiple needs. It has also been shown to improve the experience and outcomes of both patients and clinicians.
Inequalities in access
Getting care in the first place, and then experiencing the care itself isn’t as easy for some people as others.
Inequality continues to persist across health and social care. It is vital that everyone, inclusively, has equal access to good quality care and outcomes from health and social care services. It is important that you focus on the quality of care for groups of people in your community who face barriers in getting the care they need, and those most likely to have a poorer experience or outcomes. Not getting the care and treatment people need, in a way that meets their individual needs, is a breach of the Equality Act 2010. It also puts people at risk of poorer health outcomes.
We recognise the current challenges and pressures on the sector in providing safe, timely and flexible access. Despite this, you should have clear responsibilities, roles, systems of accountability and good governance to monitor these challenges. This should enable access to good quality care, treatment and support. You should act on information about access. This could be from data, feedback, complaints, risk analysis, performance and patient outcomes.
Monitoring people’s care and treatment relies on coding consultations accurately. This includes setting the location and type of appointment correctly.
For more information about monitoring see:
- Appointments in General Practice - NHS Digital
- GP Data Hub
- GP Patient Survey
- NHS England Improving GP appointment data
We do not assess a provider’s performance in relation to the contract.
For information about the contract see:
- Standard General Medical Services Contract: mentions expectations of appointments in general practice.
- BMA guidance on GP access: meeting the reasonable needs of patients: clarifies contractual obligations.
- NHS England GP Contract hub: information to support you in implementing changes to the GP contract in England. This includes how GP practices can access and help improve GP appointment data.
Integration and collaboration
By better integrating primary care – general practice, community pharmacy, dentistry and optometry – access, experience and outcomes for communities can be improved. The Fuller stocktake report looks at how integrated primary care can be accelerated across systems through 3 elements:
- streamlining access to care and advice
- providing more proactive, personalised care from a multidisciplinary team of professionals
- helping people stay well for longer.
NHS England’s drive for more collaborative working in primary care aims to improve access. See NHS England's Delivery plan for recovering access to primary care.
What we will look at
We may not look at every key question or Regulation every time we assess your practice. However, our assessments will focus on the systems and processes that practices have in place to ensure:
- Everyone can access the care, support and treatment they need when they need it.
- There is a balance of face-to-face and online/telephone appointments and a system to manage the balance of routine and urgent appointments.
- Care, support and treatment meets patients’ needs and preferences including:
- understanding and responding to the views of your patient population
- providing patients with information about how to access help and support with appointments
- systems, equipment and support to prevent digital exclusion.
- There are enough qualified, skilled and experienced people to provide safe care that meets people’s individual needs.
- You monitor patient feedback around access, including from the National GP Patient Survey, and take action to make improvements.
- You engage with external stakeholders, primary care networks and integrated care systems to share good practice and improve access
- Triage arrangements and systems to determine the clinical urgency of appointments work effectively.
- You identify and address the diverse health and care needs of your patients and local communities. Care is joined-up, flexible and supports choice and continuity where appropriate.
- Your premises are accessible, so patients are able to physically access the building.
- Patient registration
- Registration and treatment of asylum seekers, refugees and other migrants
- Looking after homeless patients in general practice
- Making information accessible
- Advanced Nurse Practitioners (ANPs) in primary care
- General practice nurses
- Health Care Assistants in general practice
- Pharmacy professionals in general practice
- Physician associates in general practice
- Primary Care First Contact Practitioners
- Regulation 9: Person centred care
- Regulation 12: Safe care and treatment
- Regulation 15: Premises and equipment
- Regulation 17: Good governance
- Regulation 18: Staffing