How will access plans affect GPs?

As the government focuses on extending surgery hours, some doctors tell Judy Sands it is time to tackle the issue.

Improving access to GP services appears to have replaced hospital waiting lists as the government's health issue of the moment.

Just as the push to reduce waiting lists involved introducing independent-sector treatment centres (ISTCs), so the plan unveiled by health minister Lord Ara Darzi to extend opening hours in primary care involves introducing more walk-in centres and services from private firms.

Lord Darzi envisages 100 new GP practices and 150 GP-run 'super surgeries'.

Jonathan Fielden, of the BMA's consultants committee, said the principle of ISTCs had been good - to split emergency surgery from elective surgery in order to help cut waiting times.

However, problems began during implementation which, Mr Fielden claimed, was not co-ordinated and revolved around where the private sector could get easy access to sites, rather than where the sites were needed.

Wasted millions
PCTs were forced to transfer cases to ISTCs because the government had guaranteed their workload.

'Millions were spent unnecessarily and the Audit Commission found that ISTCs had had little effect on waiting lists but had introduced financial destabilisation for many hospitals,' Mr Fielden said.

'However, what they did do, and this was one of the aims according to the DoH, was to have the same effect as throwing a hand grenade among the NHS hospitals in terms of efficiency and productivity. The problem is that hand grenades cause a lot of collateral damage.'

To Mr Fielden the parallels with the current situation in primary care are clear: there are not enough GPs and out-of-hours care is a shambles.

'So while bringing in outside providers will increase capacity, if the lessons of ISTCs have been learned, then it should be done in co-ordination with NHS provision and in collaboration with GPs and hospitals,' he said.

'If, however, the purpose is to throw a hand grenade in among GPs in order to get them to improve their opening hours then it has the potential to have a very damaging effect on primary care, even more so than secondary care.'

However, Dr Michael Dixon, chairman of the NHS Alliance and a member of Lord Darzi's task force on GP access, said the comparison was unjust and the government was simply using a 'carrot and stick' approach.

Dr Dixon said he believed it was time general practice responded to what the public were saying.

'I'm not talking about survey results here but what people are really saying and that is that they value general practice but their practices are not open as much as they would like,' he said. 'As GPs this is something we need to listen to, otherwise we lose the public relations battle and it will have direct consequences for general practice.

'So I don't think we should quibble too much about money for extended hours because otherwise we might just miss the battle entirely.'

Rise to the challenge
This is a view echoed by Mr Fielden, who said GPs needed to rise to the challenge of extended opening hours.

'The side issue here is that the secondary sector has now realised that it needs to adapt and change to meet public want. But at the moment the public wants better access to GP services. So I do think that GPs need to rise up to that challenge and I believe the best of general practice is already doing so.

'That's the only way to see off this kind of challenge from the private sector.'

However, GPC member and Cleveland GP Dr John Canning, said he did not believe the current proposals would in any way solve patient dissatisfaction.

'The feedback that I am always having to deal with from patients is not that they can't get an appointment when they want it but that they can't get an appointment with me,' he said.

'So what people actually want is to see their own doctor at convenient times and I'm afraid that is just not possible because GPs can only work so many hours and there are not enough of us.

'I think that bringing in private clinics and walk-in centres could make the situation worse, like when you bring in a locum when you don't often use them. It usually ends up causing more problems and you end up having to see the patient again anyway.'

Dr Canning pointed out there were two theories about carrots and sticks: 'The second is that the stick is to hold on to while the carrot is inserted at the other end. I think this government is in favour of the latter theory.'

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