It's time to rethink access to GPs within 48 hours, report says
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《英国医生杂志》
The target of ensuring that patients have access to a GP within 48 hours, as laid down in the NHS Plan ( BMJ 2000;321: 317), is a blunt instrument that fails to meet the differing needs of patients, says a review paper.
The paper, prepared for the Royal College of General Practitioners and the NHS Alliance, calls for the development of more sophisticated indicators that take account of the complexity of primary care provision.
The paper welcomes the increasing numbers of patients' groups in primary care and says that patients need to be involved in drawing up meaningful targets to meet specific local needs. This might mean introducing a transparent and auditable "menu of access," offering choice to patients about whom, when, and where they would like to consult.
"Users need to recognise and help the NHS to respond to the inevitable conflicts inherent in a resource constrained system, particularly the potential conflict between providing accessible care and personal continuous care," the report adds.
Although the 48 hour target and "advanced access" arrangements have stimulated important debate, these foundations need to be built on with a substantial evidence base, says the document, which was edited by Professor John Campbell of Peninsula Medical School in Exeter.
A contributor, Dr Iona Heath, chairwoman of the college's ethics committee, says that the existing target "prioritised an encounter between any patient and any doctor ahead of one between an individual patient and a preferred doctor."
According to Dr Heath this "may end up reducing the access of the most sick to the coordinated and personal care that they need."
High quality care of patients with several compounding health problems depends on the ability of clinicians to deliver personal and continuing care over time, she said. "Such care means that these patients need access to longer consultations," she added.
Chairman of the NHS Alliance, Dr Mike Dixon, said at the launch of the paper last week at the Royal College of General Practitioners that the central targets on access to primary care had succeeded in stopping GPs from being complacent about long waiting times for appointments.
But he said the 48 hour target had "done its job," and he called for "a nationwide system through each GP practice and each GP" to be set up that asks patients what they need from the GP appointment system.
He added that a small proportion of the quality payments to GPs depended on the views of their patients (as assessed in a questionnaire, and this could be extended to include their opinions on whether they agreed with the appointment system) and on whether the targets set were being met.
The chairman of the college's council, Professor David Haslam, said: "It would be incredibly easy to offer guarantees of same day appointments if you offered everyone one minute appointments. That illustrates the tension between access and quality. We are against simplistic targets that we honestly agree are causing harm."(Ann McGauran)
The paper, prepared for the Royal College of General Practitioners and the NHS Alliance, calls for the development of more sophisticated indicators that take account of the complexity of primary care provision.
The paper welcomes the increasing numbers of patients' groups in primary care and says that patients need to be involved in drawing up meaningful targets to meet specific local needs. This might mean introducing a transparent and auditable "menu of access," offering choice to patients about whom, when, and where they would like to consult.
"Users need to recognise and help the NHS to respond to the inevitable conflicts inherent in a resource constrained system, particularly the potential conflict between providing accessible care and personal continuous care," the report adds.
Although the 48 hour target and "advanced access" arrangements have stimulated important debate, these foundations need to be built on with a substantial evidence base, says the document, which was edited by Professor John Campbell of Peninsula Medical School in Exeter.
A contributor, Dr Iona Heath, chairwoman of the college's ethics committee, says that the existing target "prioritised an encounter between any patient and any doctor ahead of one between an individual patient and a preferred doctor."
According to Dr Heath this "may end up reducing the access of the most sick to the coordinated and personal care that they need."
High quality care of patients with several compounding health problems depends on the ability of clinicians to deliver personal and continuing care over time, she said. "Such care means that these patients need access to longer consultations," she added.
Chairman of the NHS Alliance, Dr Mike Dixon, said at the launch of the paper last week at the Royal College of General Practitioners that the central targets on access to primary care had succeeded in stopping GPs from being complacent about long waiting times for appointments.
But he said the 48 hour target had "done its job," and he called for "a nationwide system through each GP practice and each GP" to be set up that asks patients what they need from the GP appointment system.
He added that a small proportion of the quality payments to GPs depended on the views of their patients (as assessed in a questionnaire, and this could be extended to include their opinions on whether they agreed with the appointment system) and on whether the targets set were being met.
The chairman of the college's council, Professor David Haslam, said: "It would be incredibly easy to offer guarantees of same day appointments if you offered everyone one minute appointments. That illustrates the tension between access and quality. We are against simplistic targets that we honestly agree are causing harm."(Ann McGauran)