Keogh seven-day NHS plans to boost hospital support for GPs

GP should have access to senior hospital clinicians and support services seven days a week, NHS England has said.

Sir Bruce Keogh: boost support for GPs
Sir Bruce Keogh: boost support for GPs

A report by medical director Sir Bruce Keogh set out plans to move to a seven-day health service, beginning with urgent care, with a set of new clinical standards, backed by incentives and sanctions.

Sir Bruce, who will present the recommendations to NHS England’s board on Tuesday, called for support services to be available every day to help the transfer of patients from acute services into primary and community care.

Primary care services should also have seven-day phone access to ‘senior clinical expertise’, and an integrated care record, to mitigate the risk of emergency readmission.

Support services including diagnostics, pharmacy, physiotherapy, occupational therapy, social services, equipment provision, district nursing, should be opened up on weekends, the report argues.

Other new clinical standards for acute admissions cover patient experience, time to consultant review, multidisciplinary team review, shift handovers, mental health and ongoing review.

Sir Bruce’s 'Forum on NHS Services, Seven Days a Week', launched in February, said improved GP access pilots announced by the prime minister in September would begin during 2014/15 for at least 500,000 people.

BMA chairman Dr Mark Porter said healthcare should be of consistent quality across the week, and emergency services should be a priority for investment.

‘As the report makes clear, doctors are only one part of the solution. Ensuring necessary diagnostic, support and community services are accessible across seven days is also essential to making this work,' he said.

Wessex LMC chief executive, Dr Nigel Watson, said limited access to support services was ‘unhelpful’ for moving to a seven-day service but funding was the major barrier for general practice.

He said primary care must look at urgent services in a different way with ‘much greater integration of primary and community care to deliver urgent care out of hospital’.

‘Having hospitals working truly seven days a week will inevitably have an impact on access and delivery in general practice. I suspect there will be more practices looking at opening longer more of the week.’

But, he warned, the ‘main problem’ was that practices could not deliver a seven-day service with existing resources.

Seven-day general practice would need ‘significantly more’ than a 1-2% funding increase, said Dr Watson.

Sir Bruce said: 'It seems inefficient that in many hospitals expensive diagnostic machines and laboratory equipment are underused at weekends, operating theatres lie fallow and clinics remain empty. This while access to specialist care is dogged by waiting lists and GPs and patients wait for diagnostic results.

'We should also consider whether, in the 21st century, it is still acceptable for the NHS to expect people to always take time off work to access healthcare or to support a relative or friend to do the same?  This has an economic impact as well as an impact on patient and family experience.

'This is not just about hospitals but the whole NHS system.  One part cannot function efficiently at the weekend if other parts don’t.

'If people are to experience genuine seven-day treatment and care, we must look beyond emergency services and beyond the services offered to hospital inpatients.  We need to make similar improvements across primary, community health and social services, removing barriers between organisations.'

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