Labour’s analysis on five million ‘denied’ GP appointments fact checked

1 in 7 denied GP appointment — Five million patients were unable to book a GP appointment when they tried to make one in October, analysis has suggested

5 million patients were unable to book a GP’s appointment when they tried to make one in October

Many media outlets, including the Times, Mirror, Independent, Guardian, PA, Sun, Evening Standard, LabourList, ITV and MailOnline, have reported analysis by the Labour party, which claimed that a little over five million people in England were denied GP appointments in October 2022.

Labour’s shadow health secretary Wes Streeting also posted the Times’s front-page article in a tweet that was shared by many other Labour MPs.

The headline figure was reported in slightly different ways. For example, Labour’s press release and the Times print edition referred to the number of patients who had been “denied” an appointment, while the Independent said the number was for those who “could have been unable to book a GP appointment when they tried to make one”.

Labour’s five million figure is based on several assumptions that may not be right, which means that it does not reliably represent the number of patients who were “denied” or unable to book an appointment in October 2022.

As far as we can tell, it isn’t possible to estimate this number reliably with the available data, and health policy experts we’ve spoken to haven’t been able to suggest an alternative. So it’s not clear whether Labour’s figure is an underestimate, an overestimate or broadly right.

GP practices in England delivered a record high number of appointments in October 2022. However, the share of people waiting more than a week for an appointment also rose to the highest rate since May 2020.

Full Fact has contacted all the publications listed above for comment, and the MailOnline has since amended its article. We’ve also contacted the Labour party and Wes Streeting for comment.

What Labour did

According to the notes in Labour’s press release, it used the latest GP Patient Survey to find the percentage of people who did not get an appointment (and were not helped in other ways) the last time they tried to make one.

Labour then extrapolated from this figure, assuming that for every million appointments that patients get, a certain number of appointments must have been denied, and applied this ratio to the number of appointments that took place in October.

Specifically, Labour found that 15.4% of people surveyed did not get an appointment, but that 10.3% of these people (1.6% of the total) were helped in other ways, leaving about 13.8% of the total who did not get an appointment and were not otherwise helped.

It then took the number of GP practice appointments that happened in England in October 2022, which was 31,989,580, and presumed that this was the 84.6% of attempted appointments that actually happened (ie, 100% of patients minus the 15.4% who did not get an appointment). It then assumed that 13.8% of the total number of attempted appointments didn’t happen and the patient was not otherwise helped, and used this figure for the number of “denied” appointments.

If you divide 31,989,580 by 84.6 then multiply by 13.8 (using the exact percentages before rounding), you get 5,223,376—which is the 5.223 million appointments that Labour said in its press release that patients had been unable to book.

However, several of the assumptions behind this calculation may not be right, meaning the final estimate is not reliable.

Labour’s estimate is based on a survey from earlier this year

The most recent GP Patient Survey, on which Labour’s estimate is based, was published in July 2022 and conducted between January and April 2022, making its results at least six months old by October 2022.

The survey asked people to describe their last experience of booking a GP appointment, which could have been months before—for 13.5% it was “more than 12 months ago”. This cannot be used as a reliable guide to people’s experience of attempting to book during a specific month later in 2022.

The problem with taking the ratio of successful and unsuccessful bookings from early 2022 survey data and applying it to the total number of appointments in October is that it can’t reflect any changes in GP appointment availability that may have happened in the past six months.

Instead, it just assumes that as the number of appointments rises and falls, the number of unsuccessful attempts to book them must have risen and fallen too. By that logic, if GPs improved patients’ experience by offering and delivering more appointments, this method would suggest they were also denying even more. (By the same token, if GPs were hypothetically to deliver no appointments at all next month, Labour’s methodology would suggest that no patients were denied any.)

In reality, we just don’t know how many appointment booking attempts were unsuccessful in October, or how the success rate has changed since the survey.

The relative age of the survey data was also highlighted in the response to Labour’s figure from the Department of Health and Social Care, which according to the Independent claimed that the estimate was “inaccurate” as a result.

Were all these patients really ‘denied’ appointments?

Labour’s analysis and some of the reporting of it also assumes that all the patients who did not get an appointment were “denied” one, if they did not say they were helped by the practice in other ways. This isn’t necessarily correct.

The survey results on this question (which allowed multiple responses) say that 42% of those who did not get an appointment said it was because they were “not offered an appointment”. However the 15.4% of those surveyed who did not get an appointment also includes patients who were offered appointments they chose not to take, with some choosing responses such as “there weren’t any appointments available for the time or day I wanted”, “the appointment wasn’t soon enough” and “I couldn’t see my preferred GP”.

Some of these patients might have been effectively denied an appointment, if it was only available at a time they couldn’t attend. But in other cases an appointment might have been available but inconvenient, or only available with someone who was not their preferred GP.

Labour’s press release partly acknowledged this by saying: “The most common reasons [that patients did not get appointments] were that GP practices were not allowing patients to book ahead and there weren’t any appointments available when patients wanted them.”

Are we talking about patients or appointments?

Labour’s analysis seems to be an attempt to calculate the number of appointments that were not successfully booked, but the party’s press release uses the figures to talk about the number of patients affected. That appears to be based on an assumption that every unsuccessful appointment request came from a different patient.

However some patients may attend more than one appointment in a month, so this may not be the case. For instance, it has been previously reported that about 10% of patients account for 30-50% of GP appointments.

Labour’s analysis also used GP Patient Survey data on the number of patients reporting an experience and applied it to the number of appointments that took place in October. This could potentially skew the final estimate if, for instance, patients who more often try to book appointments are on average more or less likely to be successful.

What does other data show?

The GP Patient Survey suggests that it did get significantly harder to get an appointment between early 2021 and early 2022—when 15.4% of patients said they weren’t successful when they last tried, up from 10.3% the year before. But that doesn’t mean we know what’s happened since. There are signs that other parts of the health service are currently under increasing pressure. For instance, in England, the percentage of A&E patients who are admitted, transferred or discharged within four hours of arrival has fallen during the year. There is also some recent data available on the waiting time for GP appointments. Experimental statistics from NHS Digital (meaning they are “in the testing phase and not yet fully developed”) include data on the time between booking date and appointment date by month.

These show that the percentage of appointments that happened more than a week after they were booked rose to a high level in October 2022. The percentage that happened more than two weeks after booking had also risen to a high level, and the percentage that happened on the same day was at a low level.

This might indicate that GP appointments were in a sense “harder” to get in England in October, if patients had to wait longer for them.

On the other hand, it might mean that many patients who could not previously get an appointment were managing to do so, albeit with a longer wait. And, as we’ve said, the number of appointments in October was at a record level.

In short, it doesn’t necessarily mean that more people were being denied appointments in October altogether. 

The GP Patient Survey at the beginning of the year also found that just over half of all the patients who needed an appointment said they had avoided making one at some point during the previous year.

This was a rise compared with 2021, and the number of people saying they avoided booking an appointment “because I found it too difficult” also rose. This doesn’t tell us anything about patients’ experience in October, but it does make it clear that many patients may not even attempt to get appointments when they find it too difficult.

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