Conservative conference: nine-to-five general practice won't wash

GP practices must open seven days a week because a nine-to-five weekday service simply 'will not wash anymore', a Conservative MP and former GP has warned.

Dr Sarah Wollaston: seven-day general practice

At the Conservative party conference in Manchester on Monday, Totnes MP Dr Sarah Wollaston said a seven-day GP service was something ‘we must do’, although it would be impossible without more GPs and primary care nurses.

Dr Wollaston said general practice remains the jewel in the crown of the NHS, and removing its gatekeeper role would lead to waste and lower-quality care.

But in areas where practices were struggling to recruit partners or performance was poor it may be time to shift to a salaried GP service, she argued.

Dr Wollaston told the conference: ‘General practice I’m afraid has sort of restricted itself towards thinking they are just a nine-to-five service.

‘That is just not going to wash anymore. It is going to have to change but in order to do that with the sheer numbers of the workforce crisis, we are going to have to see much more partnership working, bringing in more district nurses and more nurses within primary care.

‘We just simply cannot deliver it with the number of GPs we have now.’

Responding to recent calls for a rethink on GPs’ independent contractor status, Dr Wollaston told GP that where the current model was working, practices should not be forced to change.

‘I think we do need flexibility,’ she said. ‘Undoubtedly having a partnership model in many areas has driven great efficiencies within primary care. I still believe [general practice] is the jewel in the crown of the NHS. It is not because I am biased.

‘It offers great value for money and patients like it. When you ask patients what they think of their GP, there is great affection for our model of general practice around the country.

‘But there are areas where it is failing and we can’t get the partners and in those areas, yes, of course we are going to move increasingly I suspect to a salaried model. We don’t need a one-size-fits-all.’

‘We have to look absolutely at what is most appropriate for that area. And if you cannot find partners within an area and general practice is delivering poorly, then we need to look at it differently. In other parts of the country where it is working well, let’s not force a city-centric model onto areas where what they have works well.’

More GPs would be needed for the government’s plans to make GPs accountable for 24 hour care for the frail elderly, she said. But she refused to comment on whether GPs should receive a pay rise next year.

‘The workforce crisis hangs over all of this debate,’ she said. ‘We aren’t going to deliver the aspirations we want for general practice unless we address the workforce crisis. Once we have GPs in place, of course we can be much better at delivering a named GP.

‘I am not going to get into a debate about a pay rise because there is a challenge for all public sector workers.’

However, the Totnes MP said the mantra that GPs are ‘terribly rich, all overpaid and not working any hours’ was wrong. ‘GPs have taken a real-terms cut in their income and many have been working under huge pressure in difficult circumstances. I still think general practice is a fantastic career to go into and we shouldn’t be trying to put people off.’

Dr Wollaston warned against removing GPs’ gatekeeper role.

‘It is the wrong discussion to be having. I know it is very fashionable with some of the acute sector but it is actually the worst possible thing we could do. GPs deliver great value for money, being at the heart of integrated care for older people particularly and we would abandon it at our peril.’

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