Published: 29/07/2004, Volume II4, No. 5916 Page 6

Strategic health authority chief executives have been warned to clamp down on primary care trusts that allow GPs to report success on 24/48-hour access targets by preventing patients booking ahead.

A strongly worded memo sent out by Department of Health director of access Margaret Edwards tells SHA chief executives that 'operating appointments systems which embargo or restrict booking ahead by patients [are] not acceptable or good practice'.

SHAs have also been asked to remind PCTs that 'when validating the monthly primary care access survey, they are expected to ensure that practice figures are reported on the basis of appointment systems which allow appropriate flexibility in booking appointments.' Ms Edwards warns: 'Not making these checks is a serious performance failure.'

The booking practice raises doubts over the authenticity of apparent continued improvement against GP access targets.

Figures from June show that nationally 98.5 per cent of patients are now able to see a GP within 48 hours.

The same memo confirms revelations by HSJ about a mysterious rise in demand for accident and emergency treatment. The note, sent out on the day HSJ's snapshot survey revealed the trend (news, page 6, July 15), confirms that nationwide demand had risen by 6 per cent during 2003-04, and that the increase follows years of low or negative growth.

Ms Edwards says there is no evidence that the rise is linked to GPs opting out of providing outof-hours cover under the new GP contract or to targets allowing access to a health professional or GP within 24 or 48 hours respectively.

She says the most likely explanation for some of the increases is changes in the way performance is counted against the target to deal with patients within four hours in A&E. Now trusts are required to include attendances at minor injury units in their figures.

But she suggests this may not be the only reason for the rise in demand: 'We are keen to investigate further the rise in A&E attendances. To support this, we have encouraged NHS trusts to chart hour of day and day of week A&E attendances.'