Viewpoint: How the government will fund a seven-day NHS remains a mystery

Chasing the politically-driven pipe dream of a seven-day NHS is impossible when existing services are under unbearable strain, warns BMA deputy chairman Dr Kailash Chand.

There is no doubt that the medical needs of the public remain significant at weekends. Along with the BMA, I fully support the idea of seven-day NHS services provided we have the human and infrastructure resources to deliver them.

A fully functioning seven-day health service within the existing NHS budget, however, is not achievable and will need even more money than the sums already pledged.

Further, increasingly we are facing a chronic shortage of many different types of medical staff – nurses, GPs, paramedics, radiologists, A&E doctors and many others. No one expects those to be alleviated any time soon. The BMA is rightly demanding that prime minister David Cameron set out how he plans to introduce more seven-day NHS services, including how they will be funded, how they will be staffed and how he will ensure that mid-week services are not affected.

Many GP and hospital services are available around the clock, seven days a week. Ambulance services, maternity services, out-of-hours GP services, accident and emergency care and some other acute hospital services already operate around the clock across all seven days in all parts of England. For example, many hospitals also provide emergency surgery outside normal working hours.

GP services are already struggling badly just to provide a weekday service. There are physically not the GPs or the funding to support practices who might be under pressure to open for an extra two days while maintaining their regular opening hours.

And this is the central problem. Politicians have given no practical explanation of how they are going to fund this extra care. I have heard one health leader suggest that we would need thousands of extra GPs and millions of extra pounds to make seven-day opening work – and that is without taking into account  the receptionists and nurses we would also need.

The prime minister’s £150m Challenge Fund - assured for just one year - is a mere drop in the ocean. Given that it takes 10 years to train a GP, how are we going to make this happen soon? And if we were to do that, will the balance of GP cover change with fewer GPs being available during regular hours?

Seven-day GP services

If out-of-hours and weekend work proves more lucrative, some will surely prefer to earn more, doing fewer hours than providing a service during usual surgery hours. Social care has been decimated in recent years – how will Mr Cameron make sure support and community services are also in place over seven days?

The NHS model of universal healthcare is still envy of the world, and general practice remains the ‘jewel in the crown’, led by a workforce dedicated to delivering free healthcare for all, wherever and whenever patients need it.

Without explaining and in absence of a honest dialogue with the profession, how do you, prime minister, intend to deliver a seven-day NHS? This politically driven promise risks damaging the existing NHS services on which we all rely. We need a long-term, sustainable plan that fixes the problems overwhelming the weekday service before we consider opening at the weekend. There is no point chasing a pipe dream when the current foundations of the NHS in general and general practice in particular are under such strain.

  • Dr Chand is BMA deputy chairman but is writing for GPonline in a personal capacity.

Photo: Wilde Fry

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