Seven-day general practice: a step too far for overstretched GPs

General practice is stretched to the limit - it's time for the government to drop its obsession with seven-day routine GP services, says BMA deputy chairman Dr Kailash Chand.

Health secretary Jeremy Hunt recently said the government was very pleased with the progress made by the pilot programmes launched in 2014 and 2015 to provide enhanced general practice at evenings and weekends.

He hinted that the government is considering diverting more funding into maintaining evening and weekend GP access pilots set up under the prime minister's Challenge Fund.

But the evidence is that most of the 8am to 8pm GP access pilots have failed, and the question is not just 'can we' but 'should we'?

Seven-day GP services

Proposals for seven-day services for GP practices are not being questioned by doctors because they are bad in theory – it is the cold hard practical facts that are raising concerns that this plan is completely undeliverable.The danger is that in order to provide services seven days a week, 8am to 8pm, you de-stabilise other parts of the service. We haven’t the GPs, nurses or the support staff to do the hours we are already contracted to do, never mind an extended 7/7 service.

The real question for the government is how it plans to deliver additional care when the NHS is facing a funding gap of £30bn and there is a chronic shortage of GPs and hospital doctors. Even Simon Stevens, the chief executive of NHS England, has suggested that progress towards seven-day services may not be the top priority because of cash shortages and the need to make other changes.

Ministers are misleading the public in their drive for a seven-day GP service. Seven-day GP access is impossible when the current system is already under strain, and this politically-driven promise risks damaging the existing GP services on which we all rely.

There is no point chasing a pipe dream when the current foundations of the NHS in general and general practice in particular are under such strain. Patients will suffer as GP services, which are already at breaking point, will have to spread even further. Many GP practices already open some evenings and some for a period on Saturdays.

GP access

General practice has always had an ethos of trying to improve opening hours and patient access.It is estimated that despite declining resources, GPs are delivering 40m more consultations each year than they were in 2010 – precisely because they are working extra hours to deliver more.

But we are now at the limits of what GP services can provide. Demand for appointments is soaring, especially from an ageing population with multiple health conditions. At the same time, resources are being squeezed. Two thirds of the funding going into GP practices is being swallowed by expenses: the utility bills, the upkeep of the building, the cost of vital staff like receptionists and nurses. Added to this there is an emerging workforce crisis.

Rather than making unachievable headline-grabbing promises, we need prime minister David Cameron to focus on addressing the pressures facing GP services so that we retain the current workforce and attract young doctors to become GPs. Greater Manchester, like other regions in England, is facing an urgent shortage of GPs. Around a third of doctors in the region are looking to quit the profession in the next five years.

The closure of GP-led walk-in centres, hospital beds, mental health services and community services is placing worrying pressure on elderly care and primary care services. GP services are struggling badly just to provide a weekday service. There are physically not the GPs or the funding to support practices suddenly opening for an extra two days, while keeping their regular opening hours. We need a long-term plan that fixes the problems overwhelming the weekday service before we consider opening at the weekend.

History will not forgive this government if, without the constraints of coalition, it contributes to the decline of general practice, which remains the jewel in the crown of the NHS.

Photo: Wilde Fry

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