June 30, 2015, by Public Social Policy

A `New Deal’ for GPs – 7 day working

by Professor Ian Shaw

In my blog back in May  I predicted that 7 day working for GPs would not happen and outlined the reasons why.  The Government have since come up with its `New Deal’ for GPs who agree to 7 day working  in which they offer some incentive payments for GPs who agree to the scheme.  Let me tell you why I remain unconvinced that this will happen on the scale the Government wants…

  1. 7 day working is not evidence based. If you want to persuade GPs to do anything that doesn’t involve significant incentive payments then they have to be convinced that the reform is worth doing from a patient perspective. In other words that there is a firm evidence base that this is the right thing to do. GPs remain unconvinced that this is the correct way forward. This was the question raised by Dr Chaand Nagpaul, the GP leader of the BMA, when he suggested that the Government would be better “supporting practices during the day” . The reason he said this is that on average patients see their GP 5 times a year, but this increases to 15 times a year for under 5s and over 20 times a year for patients over the age of 75. So the largest demand comes from groups who usually have little problem presenting themselves to the doctor during the day. Those practices that have tried 7 day working report that demand is very low, particularly on Sundays. It’s certainly true that GPs need to see more patients if the pressure on A&E and other hospital services is to be reduced, but that can be achieved during current working hours rather than by extending hours, with additional support staff and with `leaner’ working practices.
  2. The Government doesn’t understand the nature of the GP workforce, which has become increasingly feminised, particularly over the last decade, and has seen large increases in part time working. Indeed when GP payments were increased as part of the 2004 GP contract, many GPs saw it as an opportunity to work less for the same money rather than as an incentive to work more hours…
  3. As an aside I think it’s interesting that the Government is arguing that there is a `crisis of leadership’ in the NHS . I think in part that’s because doctors won’t go along with the Department of Health’s plans and that’s in turn because they are either perceived as not evidenced based or because doctors are so `reform fatigued’ that they prefer to concentrate on the day job and have switched off to calls for yet more reforms in their practice. GPs in particular are retiring faster than they can be recruited, and are reportedly struggling to meet current demands, let alone engage in reforms.
  4. The `golden handshake’ for GPs to work in deprived areas is welcome – but then it’s not a new initiative. PCTs had the power to do this pre 2012 but there were often few takers. GPs working in deprived areas have far different pressures than GPs working in the leafy suburbs but the quality of working life is often less – refer back to point 2.

So overall I still don’t think this will happen in the way the Government wants it to, and the government may be better dropping the idea for more primary care support around existing models – linking to the Five year Forward View which has enough challenges facing it without building in 7 day GP working 



Image courtesy of Jasleen _ Kaur

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Posted in GeneralNHS reform