Government sticks to seven-day GP pledge as MPs warn of burnout risk

The government's pledge to create a seven-day NHS by 2020 was 'not invented to annoy doctors', a health minister said on Monday, as MPs warned the plans could be unaffordable and further undermine GP morale.

Health minister Ben Gummer
Health minister Ben Gummer

The House of Commons debate came after an online petition calling for a vote of no confidence in health secretary Jeremy Hunt gained more than 220,000 signatures.

MP Helen Jones (Lab, Warrington North) who proposed the debate, told MPs that 'fortunately for Jeremy Hunt' the petitions committee did not have the power to initiate a vote of no confidence. MPs therefore debated 'the issue underlying the petition, which was the contracts and conditions of NHS staff'.

Ms Jones told MPs: 'It is a long time since I last saw dedicated doctors, nurses and ancillary staff so demoralised and, sometimes, despairing. If we look at the current state of the NHS we can see why.

'A&E departments are in crisis and missed waiting time targets for the whole of last winter. GP services are struggling to cope, and patients find it harder and harder to get appointments. Last year, the deficit across trusts was nearly £1bn; this year, that is predicted to double. Yet despite all that, NHS staff work miracles every day.'

Seven-day GP services

She accused the government of treating NHS staff badly, with pay rises 'deliberately kept low' since 2010. Seven-day general practice was likely to be unaffordable, she warned.

'When there are not enough GPs to ensure timely access to appointments on weekdays, it is difficult to see how the government are going to extend GPs’ working hours without recruiting more staff.

'It is estimated that the costs of extending services beyond the current contract, with one in four surgeries open late in the evening and at weekends, would be £749m. That would rise to £1.2bn if one in two practices were open longer. That is far in excess of the money currently in the GP challenge fund. If the government intends to proceed without recruiting more staff, that will simply increase the pressures on the staff working already, leading to more burn-out, and it will be a downward spiral.'

GP/MP and Commons health select committee chair Dr Sarah Wollaston (Con, Totnes) backed the warning over the impact of seven-day general practice. 'If we were to try to provide an 8-till-8 service on Saturdays and Sundays for routine GP appointments - if we were, as this is sometimes presented to the public, to enable people to see their doctor at any time - the cost would be enormous. There are extra costs involved in manning surgeries at those times, and there are also issues to do with staff availability.

'We should focus on other priorities on this stage and be clear that there are other risks, such as undermining other out-of-hours services.'

GP contract

Paul Scully (Con, Sutton and Cheam) said the Conservatives must deliver on its election pledge to create a seven-day NHS service, and demanded more GP flexibility, criticising the impact of the 2004 GMS contract.

'GP services cannot be boiled down to some sort of retail operation such as late-night shopping or Sunday opening,' he told MPs. 'Nonetheless, we need flexibility. The 2004 GP contract led 90% of GPs to stop providing out-of-hours care at night and at the weekend. That contract, in many cases, helped to break the personal link between patients and those responsible for their care, which has been especially hard on elderly people. Caving in to the unions at that point effectively restricted GP services to a five-day service, which created extra pressure on A&E.'

Health minister Ben Gummer said: 'People are admitted sicker at weekends, which points in part to the need to do something about community and GP services at weekends. That is part of the reason why people are being admitted sicker.

'This programme was not invented by the health secretary in a speech given to annoy doctors and consultants, much as that might be the impression given by some people on Twitter. It is the policy response of a government taking seriously the clinical evidence and advice of NHS England, led by Professor Sir Bruce Keogh. We are responding to give NHS England and the providers tools with which they can deliver a seven-day NHS service in hospitals and GP practices.'

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