Primary care access in Europe: how does England compare?

Problem

In England there is political pressure to expand the opening hours of general practice (GP) surgeries, aiming towards a seven-day National Health Service (NHS). In the context of an increasing demand for healthcare services, increase in primary care provision seeks to reduce the burden on urgent and secondary care services. Evidence about whether GP opening hours affects use of emergency services is mixed, so evidence from other European countries can help inform policy.

Approach

We compared access to primary care across European countries, looking both at patient-reported access to care and standard GP open hours. We also explored evidence on the association between GP opening hours and emergency department use.

Findings

Uniform statistics on GP opening hours in European countries do not exist, but some data are available. Opening hours in some European countries varies by region or local demand, but most (22/31 countries) have an obligatory minimum ‘in-hours’ provision. Minimum GP opening hours for these countries varied from 20 hours per week in Austria to 52.5 in England. Patient surveys also reported greater access to primary care in England than in many other European countries, though doctors’ perception of access is lower than that of patients. Literature on the association between in-hours primary care provision and emergency department use presents mixed results: some cross-sectional observational studies in the UK and in Italy found a decreased use of emergency services in the context of increased GP opening hours, but other studies did not find a significant association.

Consequences

European countries offer meaningful points of comparison when considering expanding standard GP opening hours in England. Although there are insufficient data on standard GP opening times in England and Europe, it is evident that the NHS already offers a high level of access to primary care compared with other European counties. The reality of demand for further extension of GP opening hours in England remains unclear, and there is limited and inconclusive evidence about whether additional primary care access decreases emergency department use. Furthermore, any expansion of GP hours would require significant resources, for which it must compete with other health system priorities. There is a need for further research into effects of changes to GP provision on primary care access and emergency department use before further policy change in the NHS.