Longer practice hours are not instant panacea

Another DoH report on the state of general practice - another good-news-bad-news day for GPs.

Nine out of 10 patients can now see a GP within 48 hours, according to research by the Picker Institute on behalf of the DoH. And 70 per cent are able to make advance appointments as well.

So it's great news all round, because GPs are hitting another government target and patients are happy - time to celebrate.

But wait, put your party popper back in the drawer, because delivering DoH demands is not quite good enough and the goalposts are off for another stroll.

The survey also found support for longer practice opening hours and Saturday surgeries. Not surprising really, because the public is hardly going to back shorter hours. The DoH now hopes to renegotiate the GMS contract to extend surgery opening.

Of course, little thought has been applied to the practicalities of this plan - infrastructure and staffing among other things. The survey says that two thirds of patients would not mind if the practice closed during the day to allow evening opening. Undoubtedly, when they are unable to book a daytime appointment and the access figures drop off, it may be a different story.

Health minister Andy Burnham says the move to bring secondary care services into the community should also prompt longer opening, even though evening outpatient clinics are hardly the norm.

In these sweeping plans, the DoH has once again given little thought to the services to be provided. Patients requiring urgent appointments surely should not wait until 5pm. It is, in fact, the routine checks and reviews that might be better suited to evening sessions, such as the women's health clinics run in Bangor, north Wales, which focus mainly on contraception, HRT and smear tests (page 51).

Before the DoH launches wholesale reform of the GMS contract and in-hours service we need a full understanding of what services might be suitable for evening delivery and if these are a practical proposition while maintaining other standards.

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