This article relates to the CQC key question: Is your practice responsive to people's needs?
We are often asked whether access to appointments includes a practice's opening hours.
To be rated good, the practice must meet its contractual obligations to provide essential services within core hours (see below). However the contract does not require the GP practice to make a GP available in person to provide routine services to patients throughout the core hours.
If a GP practice is closed during its core hours and does not make arrangements for patients to access care, should they need it, then the CQC will consider this to be poor practice which potentially puts patients at risk. This will be considered as part of their rating.
There are no set hours for appointments within the GP contract but the opening hours need to be sufficient to 'meet the reasonable needs of its patients'.
We do not monitor whether GP practices are meeting the requirements of their contract. When we inspect and rate GP practices we use the published Key Lines of Enquiry (KLOE) and rating characteristics to determine whether a practice:
- is providing care that is safe, effective, caring, responsive and well-led, and
- they are rated as outstanding, good, requires improvement or inadequate.
There are a number of areas where there are similarities in the issues that we look at in our inspections and the requirements placed on GP practices through their contracts: one of these is access to appointments.
The GMS contract (and virtually all PMS contracts) requires GP practices to:
- provide all ‘essential services’ within ‘core hours’ as appropriate to meet the reasonable needs of its patients, and
- have in place arrangements for its patients to access such services throughout the core hours in case of emergency.
‘Core hours’ means the period beginning at 8am and ending at 6.30pm on any day from Monday to Friday. This excludes Good Friday, Christmas Day or bank holidays.
The contract does not require the practice to make a GP available in person to provide routine services to patients throughout the core hours. Therefore a GP practice is not in breach of its contract if it is closed for some time during ‘core hours’. If it is closed during ‘core hours’, the GP practice must make arrangements to meet the reasonable needs of patients to deliver essential medical services. This does not require access to records.
On our inspections we are not checking whether GP practices are meeting their contractual requirements. However, if during inspection we find that they are not meeting their contractual requirements (they are not open during core hours and have not made arrangements for patients to have access to services which meet their reasonable needs including urgent care), we will inform NHS England.
It may be appropriate and sometimes beneficial for a practice to close for a period of time, for example for staff training or practice development days. In these situations arrangements should be made to ensure that patients can access services which meet their reasonable needs.
Checking how responsive GP practices are to their patients’ needs
When we inspect a GP practice we consider whether they are responsive to people’s needs. A KLOE under responsive is:
Can people access care and treatment in a timely way?
- Do people have timely access to appointments for an initial assessment, for diagnosis and for treatment or ongoing management of chronic conditions
- Is the appointments system easy to use and does it support people to access appointments?
- Can people access care and treatment at a time to suit them?
- Does the service prioritise people with the most urgent needs, including through triage?
- Do services run on time, and are people kept informed about disruption?
To be considered ‘good’ we expect to see evidence that:
- people can access the right care at the right time
- access to appointments is managed to take account of people’s needs, including those with urgent needs
- waiting times, delays and cancellations should be minimal and managed appropriately
- services should run on time and people kept informed of any disruption to their care or treatment.
On our inspections, where practices are not open during all of the core hours yet we find evidence that patients can continue to access appointments and services (both when the practice is open and when it is closed) then being closed for some part of the core hours will not lead to a poor rating for responsiveness. The important issue we consider is whether patients can access the care they need.
If there is evidence that people:
- are frequently and consistently not able to access appointments and services in a timely way, or
- experience unacceptable waits for some appointments and services
we are likely to judge a GP practice as being inadequate for responsive.
This may apply where a practice is open during all of the core hours as well as cases where the practice is closed for some of the core hours. In these cases, we would expect to see a development plan to improve access.
If a GP practice is closed during its core hours and does not make arrangements for patients to access care, should they need it, we will consider this to be poor practice which potentially puts patients at risk. This will be considered as part of their rating.
The important point we consider in inspections is the impact on people who are using the GP practice and whether they are able to access appointments and services when they need them.
- Professor Nigel Sparrow is senior national GP advisor and responsible officer at the CQC
More CQC resources
- View the full CQC Essentials series on Medeconomics
- CQC's recommended reading to help practices meet regulations and prepare for an inspection