Primary Care activity, demand and need is poorly understood. The GPAD (GP Appointments Data Dashboard) hasn’t helped.
The main problem with GPAD is the assumptions that seem to underpin the approach.
Assumption 1: More appointments = better healthcare
Data is always built from assumptions and hypothesis. This data set looks like the hypothesis is that some GPs are not offering enough appointments, and that more appointments = better public satisfaction with general practice (on the basis that the public say that they are dissatisfied with access to their GP). Neither of these are borne out by NHSE data.
If more appointments = better satisfaction you would expect there to be a correlation between the number of appointments and better patient satisfaction with appointments. But there isn’t. We compared the two sets of NHSE data and this is what is shows:

There is no relationship between number of appointments and patient satisfaction with appointments, in fact you may as well compare satisfaction with the length of a practices name!
The GPAD data on access has no correlation with quality of care, and health outcomes. The assumption that there is a correlation is unhelpful as in fact a volume approach to appointments can lead to poor quality of care.
Complex patients need longer appointments and continuity of care. It is the quality of the consultation NOT the number of consultations that improves health outcomes (Health Foundation). We ask practices to do a ‘deep dive’ case review into one or two complex patients. What we mostly find is that patients are bouncing between short appointments, costing thousands in time (one young person had over 30 appointments, often very short, in 3 months costing circa 2K none of which had met the person’s health needs), without meeting their needs or improving their condition. Spending more time with people who have complex needs, over less appointments where you can focus on need, will improve the patients health and reduce costs. So for some people longer and less appointments = better quality.
Assumption 2: Variation in appointments is at PCN level
the GPAD data shows there is no variation that is meaningful between PCNS – the variation is all at a practice level. Here are two PCNs in the same place as a small illustration. These are neighbouring PCNS with similar demographics. Practices in PCN 1 offering according to GPAD data between 400 and 600 appointments, with a satisfaction variation between 40-90% with both the lowest and the highest satisfaction offering the same number of appointments. PCN 2 has one practice apparently offering nearly 1K appointments but with only 45% satisfaction with appointments.


When PCNs were established, founded on the experience of the Primary Care Home, one critical part of thier work as networks (not hierarchies or organisations) was to do what networks do best – learn together. The persistent requirements of PCNs to deliver and manage services has undermined the key function of PCNs which is to support their member practices to be the best they can be – to reduce unwarranted variation between practices. The GP patient satisfaction data shows that this still needs to be a major focus for PCNs.
Assumption 3: Naming will shame GPs into doing more (they are not all working hard)
Publishing this data is causing exactly the consequences you would expect if your assumption is some GPs are not offering enough appointments, and you think the way to change that is to stoke public opinion with local newspapers ‘naming and shaming’ practices for lack of access. But the data is flawed as are the assumptions behind the data and this is misleading the public. Stoking the flames of public unrest and pointing it at general practice makes everyone’s lives worse, from the receptionist dealing with massive demand and constant anger, to the clinician putting in long hours to try and care for local people, to the population who are fearful they wont be seen. The latter itself will increase demand – fear of scarcity drives up a requirement for access at a lower level of need.
Once Practices start scrutinising their own data, it may well be that we find practices are over performing – doing much more than they are paid to do. The approach of naming and shaming will shed goodwill and eat into practice’s resilience and willingness to go above and beyond. Changing the assumption to one where most GP practice and PC teams are working harder and faster than they can sustain, with local people’s needs at the heart of their work, changes how you approach performance data and how you interpret it. The headlines from GPAD could easily have been very different. As it stands the data doesn’t help understand the public feedback about their experience, or find a solution that addresses the cause of the problem.
What Now?
The NHS should do better than this in being responsible with data. We find when we work with practices the data on appointments needs cleaning up, as between 20-30% of it is wrong (double counting, mis counting, we have even found appointments lasting days…). It is highly unlikely that the data presented is accurate.
The best way to support practices to be the best they can be is to get fully behind the Fuller Stocktake to:
(a) Provide data support to practices so they can understand and differentiate their list, providing an appointment system that meets needs. This is intensive but important work. Until practices can understand the needs of people who turn up at their door they can’t provide an appointment system, or a care system that works, or even know which roles they need in their MDT.
(b) Stop pushing PCNs into being performance management organisations, and reignite the intent of these networks to be learning communities sharing good practice and solving problems together, and developing collaborative models of care. The demands on PCNs leave little room for the lifeblood that keeps practices connected – learning and sharing.
(c) Recognise and reward primary care for managing to increase its provision creatively by incorporating a range of new roles to meet need, all this whilst coping with a considerable GP vacancy rate. Thank primary care and share excellence.
(d) Build confidence in the population that primary care is open and providing a service and help people to use those services sensibly. Help primary care share how it is changing to meet increasing demand, so that there is the best chance everyone gets access. Fear is driving more demand.
(e) It is known where practices are not performing. This is more than a PCN can solve on its own, but PCNs can be the bedrock for developing collaboratives at place for primary care. Places need to dive into those practices and work out how to ensure that the practice population gets the same quality of care as their neighbours. We know that if your practice isn’t providing good care, you don’t need to move a million miles away, a great practice could be just round the corner. This level of variation needs addressing but no amount of poor data and public shaming will solve this.
(f) Take responsibility at system level for the systemic issues that are increasing demand in primary care including poverty, waiting lists (and deterioration whilst waiting), Long COVID and the Children and Young people pandemic mental health crisis. The whole system needs to get behind primary care and collaborate to meet need.
With thanks to Tony Hufflett for data visualisation