Seven-day GP services 'nonsense', says London GP leader

A top London GP has slammed plans for seven-day GP services as 'nonsense', and suggested some tools being promoted by the government to improve access could actually increase practice workload.

The comments came just hours after junior doctors, including thousands of GP registrars, returned to work after a 24-hour strike over government plans to impose a seven-day contract.

Speaking at a Policy Forum for London event on the future of health services in the capital, Hackney GP and chairman of the BMA's London regional council Dr Gary Marlowe said that while there were things that needed improving in general practice, the idea of a seven-day service was 'a nonsense'.

Much of the current policy thinking around access to general practices services, said Dr Marlowe, was based on 'very thin' or no evidence at all.

GP access

New ways of working introduced to help manage demand and access could have a negative effect, the union leader said.

'Telephone consultations in my practice have not been shown to shift or decrease demand, but often add another layer on top of what we are doing already,' he said.

There was, he added, concern about 'supply induced demand' from the greater use of technology for GP consultations. Technologies such as online video calls could also 'disadvantage some groups', he said.

Dr Marlowe called for a 'paradigm shift' away from the 'pill for every ill culture which we are being pushed more and more towards'.

Speaking alongside Dr Marlowe, Londonwide LMCs chief executive and GPC member Dr Michelle Drage also called for a shift away from the biomedical model of care which she said society was moving rapidly towards.

NHS equality

That model, she said, was not supported by evidence and was a route to all care ending up in expensive hospitals, a model she compared to the US system. Moving care into the community and social care sectors could help address the wider determinants of health, which she argued are largely social and mental health related.

Dr Drage called for greater GP access to social prescribing, access to citizens' advice and benefits advisors.

Services around general practice which deliver bio-psycho-social care should be expanded, said Dr Drage. GPs, she said, are trained in holistic medicine.

Dr Drage also made the case for GP 'micro teams' as the solution to London's health problems. 'Small is spectacular,' she said. 'It doesn't require big, grand organisations to deliver really important care to people that makes a massive difference.'

'Micro teams,' she said, 'are what really make the change on the ground and really value individuals. 

'Whatever system we take forward, whatever model. If it doesn't factor in that particular aspect of general practice, it won't deliver.'

GP federations

London has a higher than average number of single handed or small practices and NHS England has made clear over a number of years that it wants to reduce the number and encourage mergers and federations.

NHS England's programme director at the Healthy London Partnership Shaun Danielli told the meeting there had been 'significant investment' in London to support improved access in primary care. By 2018, he said, around 70% of the population will be covered by 8am to 8pm GP access.

GPonline revealed last week NHS England and the DH are preparing to announce the next stage in the roll-out of seven-day GP services. Officials are expected to announce funding and initiatives to roll out enhanced GP services developed by the prime minister's challenge/GP access fund across the country as well as new measures to support innovation.

NHS England’s mandate from government for 2015 required it to provide weekend routine GP access for a fifth of the population by 2017.

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