NHS weekend: 7-day GP opening ‘unachievable’ (within 10 years with UK trained doctors). Meanwhile GPs can get trained without being fit for purpose in OOH.

Nick Triggle for BBC News 5th September 2015 reports: NHS weekend: 7-day GP opening ‘unachievable’.

NHSreality says it could be achievable but by a variety of dubious methods. We could recruit doctors from other countries, we could encourage nurses to diagnose (with the accompanying medico legal risk), and we could pay an exorbitant fee for Out of Hours (OOH) which would lead many of the profession to co-operate, and encourage others back from abroad. We could announce an “emergency” and ask retired doctors to do sessions for the OOH services. We could announce co-payments and overt rationing, encouraging autonomy, reducing demand and allowing longer consultations. We could encourage GPs to run smaller District General Hospitals which are being downgraded, thus improving the “shape of the job“. There is no chance of success within 10 years with UK trained doctors…. With junior doctors getting upset (50,000 reasons to reverse the ‘unacceptable’ proposed reforms to their contract. BMA news 4th September 2015.) there looks to be some unrest in the profession. Scotland has acknowledged the lack of sufficient training in OOH and emergency care. Christian Duffin for Pulse 4th September 2015 reports: GPs to get one year training to work across primary and acute care. This acknowledges a major weakness in GP training: GPs can get trained without being fit for purpose in OOH, or multitasking. Is this extra year going to help recruitment? If “our health is the most important thing for each and every one of us” (Jeremy Hunt) then Mr Hunt needs to show he cares by some longer term planning, reduction of debt, and recruiting equal numbers of men and women to the profession at graduate level, and stopping the exodus..

The goal of seven-day routine GP opening in England is unachievable in this Parliament and risks destabilising care, the Royal College of GPs says.

Ministers have promised that by 2020, people will have access to GPs seven days a week – and have pledged 5,000 extra doctors to help achieve that.

But RCGP president Maureen Baker said they would largely be needed to plug gaps in the current workforce.

And she urged the government to think carefully about its approach.

There are no official figures for GP vacancy rates, but Dr Baker said evidence from its members suggested the vacancy rate could be more than 10%.

“We haven’t the nurses and the support staff to do the hours we’re already contracted to do, never mind extend those.

“Therefore, frankly, 08:00 to 20:00, seven days a week for routine general practice is unachievable.”

Dr Baker said pushing ahead with the plans in the current climate could cause problems. “The danger is that in order to provide services over those extended hours, that you destabilise other parts of the service.

“You’re fishing from the same pool, so if those doctors are attracted into that work, instead of out-of-hours service for instance, then there’s a risk that you destabilise the out-of-hours service so that people can come and have routine care on a Sunday teatime.”


Is there a GP problem?

In terms of numbers of GPs working in England, the picture is complex. Health and Social Care Information Centre data shows that, in 2009, there were 32,111 GPs once doctors in training and retainers, mainly retired GPs who do a few shifts, are excluded.

In 2014, that had risen by just over 500 to 32,628. A sign of improvement? Not quite. If the population rise is factored in, the number of GPs per 100,000 people dropped from 62.4 to 60.6.

Graph

Another way of looking at the issue is to consider waiting times. But again that is not so easy to gauge. Unlike hospital or A&E waiting, GP data is not tracked officially.

The best source of information is therefore the official GP survey carried out by Ipsos MORI for NHS England. On a number of key measures, including overall experience and ability to be seen, ratings have fallen.

Three-quarters of respondents said they were satisfied with their surgery’s opening hours last year – a drop of 4.8 percentage points since December 2012.


‘Absolutely focused’

The British Medical Association has also questioned the policy, saying investment should be concentrated on existing services.

But Health Secretary Jeremy Hunt said he was “absolutely focused” on making seven-day GP opening happen.

At the start of the summer, he reiterated the commitment made in the Conservative manifesto to recruit 5,000 extra GPs, while setting out what he said was a “new deal” for the profession.

It included promises to look at making it easier to return to the profession or work part-time as well as floating the idea of financial incentives to encourage doctors to work in areas where there were shortages. Talks with the British Medical Association are due to get under way later in the autumn.

He told the BBC the increase in GPs represented the “biggest single increase in GP recruitment over the history of the NHS”.

“We just have to recognise that it’s not just about convenience, people don’t just get ill Monday to Friday, they get ill every day of the week. Our health is the most important thing for each and every one of us.”

It was the best job in the world – for me 1979-2012 – but now there are not enough of us to cover the country

Update 6th September: Hugh Pym. The war of words over 7-day GP services – the rural issue of access is revealed:

“…

The weakness of the existing system, though, was highlighted by none other than the head of NHS England, Simon Stevens.

In a speech this week he talked of an incomprehensible “alphabet soup” of overnight and weekend services.

He said patients were left confused as to whether to call 111 or out-of-hours GPs or go to their local A&E unit.

Increasing numbers of GP practices are linking up locally to provide weekend appointments for patients who want them.

This will probably not be at their local surgery but at one which is at least in their town or community.

Mr Cameron said in his speech that by the end of this financial year, 18m patients in England would have access to a GP seven days a week.

These existing seven-day GP access schemes tend to be in larger urban communities with a varied population and with practices clustered more closely together.

Doctors in rural areas have complained that there is no demand for weekend appointments and that local patients, often with more elderly in their number, are well served by 12 hour opening from Monday to Friday……”

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This entry was posted in A Personal View, General Practitioners, Medical Education, NHS managers, Patient representatives, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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