Viewpoint: PM's seven-day GP pledge unrealistic, says Dr Kailash Chand

Prime minister David Cameron has pledged patients will have seven-day access to GPs from 2020. Writing in a personal capacity, deputy BMA chairman Dr Kailash Chand says the proposals are 'crude'.

Dr Kailash Chand: warning over seven-day GP pledge (Photo: Michele Jones)
Dr Kailash Chand: warning over seven-day GP pledge (Photo: Michele Jones)

Prime minister David Cameron's proposals to provide routine NHS services seven days a week are too crude and pander to a political agenda of wanting to look strong on the NHS and stand tough on patient safety. And yet the question remains - how do the politicians who call for a fully functioning 24/7 NHS expect to resource it when the government can hardly afford its current model, and when demands are being made to take out further billions from the NHS budget in coming years?

Extending services is costly

Opening GP surgeries 8am to 8pm during the day/evening and at weekends will cost a lot more than the £100 million pledged by Mr Cameron - and it's not just doctors and nurses working extra shifts, but receptionists, phlebotomists etc. The money simply isn't there. Furthermore, where are the additional GPs and supporting staff to deliver this? The £50m pilot project in Greater Manchester is not a resounding success by any means - five out of seven areas have yet to begin.

All efforts should be made to improve services at weekends, in the evenings, and out-of-hours, but we should not ignore those who are already working throughout the night and on Saturdays and Sundays in order to provide life saving care for their patients. People forget about the majority of GPs/consultants who provide on-call urgent and emergency care. There are 40% of GPs who do work out-of-hours. This is quite contrary to the impression being perpetuated that at 5pm everyone packs up and goes home.

Providing patient care seven days a week and patient safety above all other aims isn’t possible alongside the government’s escalating privatisation of the NHS which puts profits before patients. An injection of realism is necessary to stop the destruction of the NHS, rather than forcing reform after reform or chasing spurious projects that can only undermine the objectives of this publicly funded body and the morale of its workforce.

The government has spent the past four years pushing through changes to the NHS on reluctant doctors and unexpecting patients, yet these changes have done nothing to meet the real challenges we face.

Fuelling demand culture

Mr Cameron at the Conservative party conference is just fuelling  the demand culture, and totally ignoring the available resources, investment required and flexibility that will be needed to achieve his stated goal. For the last two decades the usual response to problems has not been to try to solve them, but to apportion blame on others, while projecting the image of safeguarding the NHS.

We all want a patient-focused NHS in general, and in general practice in particular, but this comes at a cost. Unlike supermarkets and banks, which can increase their income streams by making their service more attractive to customers, the NHS cannot attract more revenue by changing its availability to the public as the NHS works within a fixed budget. Longer routine work will mean more costs—there is only so much than can be achieved by efficiency savings and these are being already squeezed out to unprecedented levels at present.

Politicians need to work with doctors, and likewise we want to work with them. A divide and rule policy will not solve these problems but the prime minister needs to be frank with the public and professionals about the resources that are available, and what is required to improve the performance and functioning of primary care.

Politicians' own duty of candour must surely require them to engage with professionals, be transparent with the public, and above all stop politicising the NHS.

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