What have ministers done about GP access – and have they been successful?

GP access is one of the biggest political talking points, and policymakers have introduced a number of initiatives to improve it. Jaimie Kaffash evaluates how successful have they been

The THIS Institute and Health Foundation found there had been more than 400 initiatives designed to improve GP access from 1984 to 2023. These have been centred around increasing the workforce, increasing the numbers of appointments available, opening up new ways for patients to access the NHS and by making it easier to contact the practice. In this feature, we will examine four of the flagship policies in England: the additional roles reimbursement scheme (ARRS); extended hours; Pharmacy First; and Modern General Practice.

The ARRS

The most consistent policy designed to improve access has – quite reasonably – been around boosting staffing numbers, and the most successful policy around this is the £1.4bn a year ARRS, introduced after many a failed attempt to increase the number of FTE GPs.

There has already been a lot written about whether it has helped improve access, with some claiming success and others saying it has failed. As we saw in the second part of this series, it has undoubtedly helped increase the number of appointments, but it hasn’t improved patient satisfaction.

The Institute for Government concluded: ‘The enormous expansion of the direct patient care workforce, the last Government’s signature primary care policy achievement, has coincided with the largest drop in patient satisfaction on record. Our regressions also showed a negative relationship between the change in DPC staff and the change in satisfaction between 2019 and 2023. In other words, the larger the increase in DPC staff, the more likely it was that patients’ satisfaction with a practice would fall.’

Our recent survey of 334 practice managers in England found that they felt pharmacists to be the most useful ARRS role in improving access. There are some caveats to this – GPs and nurses are not yet embedded into the scheme, and ‘other roles’ were lumped in the same group.

In the survey question’s free text box, around 200 respondents specified the most useful professionals. By far the most commonly cited role was that of physiotherapist, or similar musculoskeletal (MSK) roles – with around half of respondents highlighting their utility.

Many people said physiotherapists had been a ‘game-changer’, pointing out that having these professionals within the practice allowed patients to bypass what have traditionally been appointments with a GP. Other popular roles included paramedics and mental health workers, although the latter isn’t particularly common across general practice due to problems with recruitment.

Although pharmacists were found to be useful, this wasn’t always for access. One GP said they were helpful for ‘managing cholesterol pathway, structured medication reviews, drug safety alerts and increasingly hypertension’,

Other comments from GPs included: ‘We have used ARRS admin to set up a robust medicine monitoring recall system, this has not improved access but it has significantly improved patient safety and the quality of care we provide’; ‘Not improved access particularly but they have reduced some of duty workload’; and ‘ARRS pharmacists have been huge help to us, but not necessarily with access – more with prescribing quality/safety/projects/supervision of wider prescribing team/structured medication reviews etc.’

The major theme, however, was that an appointment with a non-GP staff member may not necessarily be of the same quality as one with a GP.  The Institute for Government report found that GP partners are associated with the largest increase in total appointments. It added: ‘An additional GP partner in a practice is associated with a 1.4 percentage point increase in patients reporting a “good” service. Additional salaried GPs and nurses are also associated with an increase, but not to the same extent. Yet additional “direct patient care staff” are not associated with any increase.’

Analysis of the recruitment and employment crisis by our sister title Pulse found that the ARRS was, in part at least, responsible for GPs being out of work. Practices facing a funding squeeze are more likely to hire funded staff even if they may not be as effective. There is often also a lack of premises space to accommodate ARRS staff. This can affect the number of GPs employed, but also the number of face-to-face appointments – which the IfG found was a significant factor in patient satisfaction.

The ARRS has undoubtedly increased the number of appointments available in general practice. But this is at the expense of GP appointments, which are what patients most value. As such, there is a real question mark over its success.

Extended access

Extended-hours GP services were introduced in October 2013 by then Prime Minister David Cameron, who said: ‘Millions of people… find it hard to get an appointment to see their GP at a time that fits in with their work and family life.’

After several iterations, extended hours are now provided through PCNs, with a mandatory 60 minutes of enhanced-access appointments per 1,000 patients between 6.30pm and 8pm on weekdays and between 9am and 5pm on Saturdays.

According to NHS Digital data, in July 2025, around 367,000 appointments were provided through extended access, making up some 1.1% of all appointments in general practice. Funded at £8.52 per patient per year  – based on current general practice populations, this comes out at around £535 million. In other words, around £120 per appointment, or the same as the total global sum practices receive per patient for a year. There needs to be caution with these figures. NHS Digital suggests extended access appointments could be underreported.

In terms of patient satisfaction, numerous studies have looked at the impact. Researchers from the University of Manchester and the University of Liverpool said their analyses ‘did not identify significant linear associations between extended access services and patient experience measures’. They also found ‘some evidence suggested that the frequency of seeing or speaking to a preferred GP (a measure of continuity of care) was negatively associated with extended access services, although not linearly’.

Despite these findings, on the whole, the majority of the 797 distinct practices (see methodology) we surveyed said evening and weekend appointments had been a success where set up – although more people chose ‘quite successful’ than ‘very successful’.

But opinions from GPs were mixed. The main concern was around the effect on continuity of care. One GP in Greater Manchester says his PCN provides extra GP appointments and an overflow hub that runs through the winter. ‘Both these services have contributed to reduced waiting times but don’t really help with continuity – we often end up with referrals to make on their behalf and need to arrange additional tests as they are unable to send routine referrals and don’t seem to be able to request bloods/MSUs.’ This ‘does generate a fair amount of additional work for us’, he adds.

A Leicestershire GP says the configuration of the workforce in extended hours has an effect on continuity: ‘Extended hours clinicians are mostly not GPs or, if they are, they are external staff. So they offer no continuity of care or the access to the GP the patient wants – they can at best just help sort out acute issues, like you would get from an urgent care centre or emergency department.’

There are also various issues around take-up. There are no real official figures around take-up, but a an investigation from 2018 – before extended access had been rolled out across the whole of England – suggested that 25% of appointments were unfilled.

Anecdotally, practices suggest there are still a high number of appointments unfilled. One GP partner in south west London says: ‘We moved our extended access to within our PCN. We simply struggle to fill the face-to-face appointments on Saturdays for both doctor and nurse appointments, and all telephone calls.’

This lack of take-up can often be seen through increased DNAs, practices say. The GP in Manchester says all extended hours appointments are with GPs and are face to face – which we’ve seen are drivers of patient satisfaction – but that DNA rates seem to be ‘pretty high’ A potential cause of this is that patients are unwilling to travel. One GP in Shropshire says: ‘None of our patients have ever used extended access appointments at other surgeries. Our PCN weekend extended-access appointments are at a surgery that is 20 miles away.’

Conversely, appointments in some areas can be hard to come by, many primary care staff say. Some respondents said another problem with the PCN model was that the host surgery would often secure the bulk of available slots. One GP in Berkshire says: ‘At first it helps, but before long, all the space gets filled, or worse, the gaps are filled with even more trivial nonsense. Our shopping mall walk-in centre recently closed as it led to no reduction in A&E or GP attendance; it just meant more trivial issues were consulted for.’

Pharmacy First scheme

Since January 2024, community pharmacies are allowed to supply prescription-only medicines for seven common conditions: acute otitis media; impetigo; infected insect bites; shingles; sinusitis; sore throat; and uncomplicated urinary tract infections. The aim of the scheme is clear: ‘This new service is expected to free up GP appointments for patients who need them most and will give people quicker and more convenient access to safe and high quality healthcare.’

Our survey suggest a lukewarm response to the benefits of the scheme 18 months in: around half of 336 practice managers said Pharmacy First improved access to general practice, while around a third said it had little or no effect.

A number of respondents said the success of the scheme depended on local services: if there was buy-in from pharmacies and general practice, then patients seem to like it. Dr Grant Ingrams, a Leicester GP and chief executive of Leicester, Leicestershire and Rutland LMC, says: ‘As a practice, we were an early adopter and remain one of the highest users. But it clearly depends upon the quality of the local pharmacies.’ 

However, there were – again – a number of criticisms. By far the biggest issue was patients being sent back to general practice. Some respondents put this down to a lack of skills. One GP in Surrey says: ‘I find patients are still being referred back to us for minor ailments like UTI and earaches. I wonder if this is because of lack of training but we are ending up with the workload.’

A few GPs specifically referenced insect bites. One, from West Yorkshire, says: ‘We direct people there and often they return saying they need to see a doctor. I find for things like insect bites pharmacists will often say, it looks infected you need to see a doctor. They lack the necessary skills still to reduce workload in general practice.’ Another, in Cheshire and Merseyside, says: ‘The cases seen are so very simple that they don’t impact my workload at all. If anything, certain conditions are almost always sent back to us – usually “bites”.’

Not only do patients get sent back to their GP practice, but this often ends with an urgent, on-the-day appointment that shouldn’t be necessary. This is partly because the patient is frustrated at the extra appointment. A GP in Oxford says: ‘Invariably patients referred back to GP, often more insistent and perceived delay, patchy access due to inadequate pharmacy cover.’

There are also issues around the clinical advice provided. In addition, many GPs expressed concern around the level of inappropriate antibiotic prescribing. Typical comments included: ‘I’m concerned about the overuse of antibiotics’; ‘Only concern is overprescribing antibiotics and the effect on gut microbiomes’; ‘Antibiotics given out when I would not have given them’;  ‘Tend to use antibiotics too much’; and ‘Has absolutely and irrevocably increased patient demand and expectation for antibiotics’.

Another issue comes from patients’ reluctance to go to a pharmacist rather than see a GP. One practice manager in Norfolk says: ‘It will take further time for Pharmacy First to properly embed and become the first choice for patients suffering from minor complaints. They still feel “fobbed off” currently and carry the “I want to see a doctor” mentality.’ Another in South Sefton says: ‘Some patients refuse point blank to see a pharmacist and will only see a clinician at the surgery.’

Although all this does give a negative picture of the scheme, a point raised by many general practice respondents was that it is impossible to tell what impact it is having on the ground. As one GP puts it: ‘We cannot count what we do not see.’

The problems with access schemes

All these schemes have their benefits, but they all suffer from the same problems. Although non-GPs can hugely support general practice, the truth remains that patients on the whole want to see a GP, and appointments with GPs tend to be more effective. Any attempts to provide more appointments with fewer GPs will also fail on this point.

The same principles apply to extended access. Either this is done through GPs – which takes workforce away from routine hours care – or it is done through other staff. Without an increase in GPs, these schemes are destined to have limited effect.

There are, however, solutions that may work, and are led by GPs and their teams – which will be looked at in the final part of this series.

You can find all the data and the methodology in the full report, which can be downloaded here.

Commercial partner of this white paper: General Practice Solutions