Exclusive: Seven-day NHS plans not evidence-based, warns top GP

The founder of a major private provider of GP services has questioned the government's plans for seven-day services.

Dr Ajit Kadirgamar: questioning case for seven-day GP services (Photo: The Practice Group)
Dr Ajit Kadirgamar: questioning case for seven-day GP services (Photo: The Practice Group)

Practice Group clinical lead GP Dr Ajit Kadirgamar said that it was not yet clear that the 8am to 8pm, seven-day model being rolled out across the NHS in England is what the service needs.

Dr Kadirgamar told GPonline that while greater access was necessary there was not yet the evidence for expanding the access pilots set up under the prime minister’s Challenge Fund.

The GP, who set up the Practice Group private provider company 10 years ago, said that many of the pilots established by the Challenge Fund to increase GP access were just replicating the in-hours service rather than developing the more innovative models of service delivery required.

Is seven-day NHS needed?

‘I don't think we know yet if seven-day working is what we need. I don't think we know yet if 8 till 8 is what we need. I think it sounds good, when the prime minister stands up and says it,' Dr Kadirgamar said.

‘What we do need is better access for planned care. We do need something outside 9am to 6pm. We aren't going to be able to deliver that with a traditional model of, turn up and see the GP of your choice,' he warned.

The government and NHS England have said that 18m patients will have evening and weekend access through a Challenge Fund pilot scheme by the end of 2015. An initial wave of 20 pilots announced in April 2014 received £50m funding and were later extended with additional funding until September 2015.

Another 37 pilots were revealed in March 2015 and received £125m. The Conservatives pledged before the election to spend a further £500m over five years to ensure every patient in England has 8 till 8, seven-day access to general practice.

The Practice Group, which runs 18 networked GP practices as well as walk-in centres and specialist services has some practices covered by local Challenge Fund pilots.

Transforming NHS care

‘I do think that the models done through the prime minister's Challenge Fund have largely been essentially replicating what goes on in-hours in the out-of-hours period, not really transformational,' Dr Kadirgamar said. ‘These projects are mostly in their infancy at the moment, and we haven't really seen the outputs of them. It's a great leap to say, yes we definitely need 8 till 8, seven-day access, and I don't think we know that yet.’

Dr Kadirgamar said what was needed was better access to planned care delivered with a wider primary care team making better use of technology to deliver new types of consultations and to provide better access to medical records.

The Practice Group, said Dr Kadirgamar, uses its network of practices to share resources and demand, shifting administrative work to practices with more capacity and using their IT system to provide telephone consultations for patients from GPs at other practices to cope with capacity problems caused by under resourcing or recruitment problems.

Dr Kadirgamar said expanding access, as well as changing GP work patterns, may mean continuity of care doesn’t come from seeing the same GP every time, but from better use of clinical records. ‘If our options are to have limited access or improved access with a range of professionals using the same clinical record, I still think that is a quality service,' he said.

The Practice Group, which has venture capital fund MMC Ventures Ltd as its major investor, has faced criticism in the past for closing what it has said were unsustainable practices.

The group has built its business by taking over GP contracts for practices facing possible closure or suffering recruitment problems. Dr Kadirgamar said this means many of their practices in deprived urban areas suffer underfunding, forcing the company to find innovative solutions to improve access for patients.

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