May 21, 2015, by Public Social Policy

GPs and 7 day working

by Ian Shaw

Cameron’s announcement of 7 day working 8am-8pm for the GPs by 2020 so soon after the Election may have been his way of reassuring the public that the NHS was safe in his hands, but it’s not really going to happen this parliament and there are a number of reasons for that:

Firstly, GPs are complaining that their services are close to breaking point. `Working differently’ may bring some efficiencies but the majority of GPs are too busy doing `the day job’ to engage with any organisational change that may impact upon their practice. As one GP told me this morning “Bringing in other professionals will impact on continuity of care and even when this has been tried in the past the overflow comes back to the GP so what looks good on paper often doesn’t work in practice”.

Secondly, 7 day working means additional resources. The £8 billion promised this week will only keep the lights on in the face of increasing age related demands for care – it won’t provide resourcing for 7 day working.  Hunt has promised an extra 5,000 GPs but this raises other questions; a) It takes 7 years to train a GP, so that’s beyond the 2020 timeline; b) the Government could try and divert registrars in other specialties to train as GPs and shorten the time but that will require incentives (which the Government doesn’t seem to have) and making General Practice less rather than a more pressured environment… The BMA have called the proposals `surreal’ and point out that GPs will retire faster than they are recruited  .  The NHS could ditch its ethics and try and recruit doctors from developing countries – but then that would fly in the face of the Governments recently reaffirmed migration targets  !  Also, the NHS’s experience of overseas recruitment of GPs is not that happy, in that it takes incoming doctors a few years the `bed into’ the British culture and the NHS’s ways of doing things (if they stay, and many haven’t).

Third, the BMAs reaction is indicative of a wider realisation that Cameron does not understand the NHS or the workforce crisis it is facing.. The report he quoted in favour of the scheme is based on some research back in 2012 by University College London that says mortality rates are higher at weekends, but the NHS’s own website debunks any relationship between this figure and staffing levels: “This study has not examined the reasons why there may be an increased risk of death with weekend admissions and no assumptions should be drawn about staffing levels or the availability of senior staff”

There may be some local pilot 7 day a week sites getting off the ground (there is one starting in Erewash for example) but doing it on a national basis would need either extra resources the government claims it does not have;  the goodwill of GPs, which has now dwindled fast; or a renegotiation of the GPs contract, which would move GPs from Independent Practitioners into a salaried workforce – something which Bevan didn’t manage and which won’t happen quickly of without a fight…


Image courtesy of  Dr. Farouk 
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Posted in GeneralNHS reform