Seven-day NHS: Jeremy Hunt must realise that seven-day working will undermine GPs

Stretching under-pressure GP services across seven days a week will deepen the crisis already facing the profession, warns BMA deputy chairman Dr Kailash Chand. Writing for GPonline in a personal capacity, he asks why the message doesn't seem to be getting through to health secretary Jeremy Hunt.

Health secretary Jeremy Hunt again reiterated to the House of Commons health select committee this week that seven-day routine GP services had been a ‘clear manifesto commitment’ and that the government would push ahead with the policy.

What will it take for the health secretary to realise that seven-day GP opening will deepen the recruitment and retention crisis in general practice?

At last year’s LMCs conference in London, GPC chairman Dr Chaand Nagpaul urged the health secretary to drop his ‘surreal obsession’ with seven-day GP services, warning that surgeries were already at breaking point.

NHS workforce

According to a public accounts committee report published on Wednesday, in 2014 providers reported that they were short of around 50,000 clinical staff. This undersupply inhibits trusts’ ability to provide services efficiently and effectively and is resulting in longer waiting times for treatment and shortcomings in the quality of care.

And now, our political masters want this depleted, overworked, overtired and stressed workforce to provide a seven-day NHS. It is a recipe for many more Mid Staffordshire tragedies.

I’ve argued before on GPonline that nobody disputes access to GP services needs improving. But prioritising weekend and evening access at the cost of access and services during normal hours is neither right, nor desirable - access must be based on need, and GPs must be allowed to tailor their services according to local demand.

Without doubt, there is a small number of patients who have difficulty accessing healthcare in normal weekday hours – which, incidentally, run from 8.30am to 6pm, not 9am to 5pm as some seem to believe.

Seven-day GP services

The pilot in Manchester is seen as a test bed for prime minister David Cameron’s ambition to roll out seven-day GP access to the whole of England by 2020. In my view, however, it is a political pipedream – in some areas of the country, CCGs have shelved their extended access plans due to lack of demand.

So the question remains: how does Jeremy Hunt, who calls for a fully functioning 8am to 8pm, seven-day NHS, expect to resource it? We can hardly afford the current model, and demands are being made to take a further £30bn from the NHS budget by 2021 as efficiency savings. These measures will only increase demand and fail to take into account the available resources, investment and flexibility that will be needed to achieve this.

Is it not a fact that we already have access to GPs around the clock? It is called out-of-hours. Surely Mr Hunt should be increasing funding and supporting a robust out-of-hours service, rather than diverting it to provide routine care?

GPs will tell you that they are perplexed as to how they are supposed to provide this service when they can’t even provide enough appointments during a standard working day. Mr Hunt needs a reality check and needs to understand that what GP services need is a long-term, stable plan that gets them back on an even keel.

This means better funding and a sensible recruitment plan, and also a wide-ranging look at how we can support new services in general practice and release the experience and potential that GPs and patients have to shape services locally.

Politicians make promise after promise from the podiums, each more lavish than the last and ever more detached from reality. Given the scale of the workforce shortfall in primary care, seven-day GP services as promised to the public look completely unrealistic, neither desirable nor wanted.

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