This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

Gold, incentives and meh

Dr Ivan Benett: ‘Be positive about seven-day access’

Sofia Lind speaks with the left-leaning CCG clinical director who has the PM’s ear on why Government plans for seven-day GP access are the only way to keep the NHS sustainable

Dr Ivan Benett does not look like a man about to visit Number 10. He is relaxed, unshaven and has long curly hair that touches his shoulders.

But he is talking to Pulse immediately before speeding off in a taxi to Downing Street outline his CCG’s plan for seven-day GP access to David Cameron’s special adviser.

It could make for an interesting meeting. Dr Benett is a straight-talking, left-leaning GP who insists he is only in the CCG business to ensure that the NHS remains a publicly funded service.

He says: ‘For me the absolute bottom line is the sustainability of the NHS. I believe very passionately in the NHS and anyone who has followed my career will know that. I am driven completely by a wish to see the NHS work.’

And he is a man of his word. Before becoming clinical director of NHS Central Manchester CCG, which coversa patient population of 200,000, Dr Benett was known for standing as a Pulse-backed independent candidate in the 2005 general election in protest at the then-Labour Government’s NHS reforms.

He says his message to Mr Cameron will be that the Government must allow CCGs to free up additional resources and experiment with new ways of working:  ‘Don’t be too restrictive on what individual places want to do, let them experiment with new ideas and see which ones work.’

He speaks to Pulse as his own CCG experiments with opening GP practices seven days a week – an idea that the Prime Minister and health secretary Jeremy Hunt have both made clear they intend to roll out nationwide.

Indeed, the Department of Health slipped up when it issued a press release last autumn hailing the ‘success’ of Manchester’s seven-day GP access scheme when the service at the time had yet to see a single patient.

Dr Benett balks at any suggestion that his CCG’s move to expand GP access was politically driven, though he says he was happy to see the scheme recognised by the DH. He says: ‘We were very pleased, but we weren’t driven by their policies. We were going to do this anyway. We were quite clear about this.’

He adds: ‘I believe that we may have influenced their policies rather than the other way around.’

Pioneering

Central Manchester was one of a group of Greater Manchester CCGs to win funding last year from NHS England’s £2m ‘demonstrator’ pot of money for pioneering new models of general practice.

The CCG has used this money to give 50,000 local residents access to GP services between 8am and 8pm on weekdays and for three hours on Saturdays and Sundays for routine and emergency appointments. The scheme has been running since before Christmas.

Not all practices are open during these extended hours. Practices are grouped into four locality areas, each covering eight to 10 surgeries and 50,000 patients. Each locality has a hub practice providing the extended hours appointments. When other surgeries in the locality are closed, patients are directed to the hub. The hubs have access to GP records from all practices in that locality. Eventually those records will also be shared with emergency and urgent care services, and GP appointments will be bookable directly via NHS 111 and out-of-hours services.

Dr Benett believes it is too early to predict demand for the expanded access appointments, but a similar scheme in Durham has seen 7,000 patients accessing GP services at the weekend in the first 11 weeks of its trial.

He says: ‘We will have to wait and see. But we believe we need to divert around one patient per 1,000 population per week from A&E attendance. I think that is reasonable.

‘That equates to about 50 extra appointments per week in each locality and that is provided for. On top of that, to manage long-term conditions out of ordinary hours we have commissioned another 46 appointments.’

CV

Age: 57

Home: Didsbury, Manchester. I live alone, and with friends and guests from time to time, including asylum seekers sometimes.

Family: Four children and one grandson.

Education: Manchester Medical School. Masters in medical science from the University of Birmingham and diploma in cardiology for GPSIs from Bradford University.

Career history:

1985-present: GP principal (salaried since 2012);

2005-present: GPSI in cardiology;

2010-present: clinical director for Central Manchester CCG.

Career highs:

• Awarded best contribution to a quality service at NHS Heart Improvement Conference 2010. • Protested against the Labour Government’s health reforms as Pulse’s independent election candidate in 2005.

• Introduced a GPSI cardiology service in Manchester.

Interests: Watching Manchester United, travelling, spending time with my family.

Wider plans

Dr Benett sees the extension of GP access as part of a wider project to ease the pressure on emergency and secondary care.

He says: ‘We have all the problems of any inner-city area, with a relatively deprived population and an increase in acute admissions and in A&E attendance. Those are two big challenges as well as the high mortality rate that goes with an inner-city population.

‘We primarily wanted to tackle those issues by developing primary care and that means building up the capacity and expertise in primary care but also offering patients a wider choice of availability of access to GP practices.’

The CCG is also investing in an education programme led by hospital specialist nurses to develop better skills at GP practices, a new nurse-led dementia action team and better collaboration between GPs and hospitals on end-of-life care.

Dr Benett says: ‘We have developed several schemes. We have done that by building on the practices that already have expertise, and also getting specialist nurses out of the hospital to work with practices that haven’t trained up to the local enhanced service [for dementia].’

The CCG is also looking at new ways of contracting GPs and hospitals to ensure they are working to the same goals, including aligning CQIN and LES incentives.

Dr Benett says: ‘We are starting to talk about so-called “alliance” contracts with secondary care hospital colleagues, whereby we share the contract with all providers across primary, secondary and community care so that we can enable that movement of activity to come out and be much closer to where patients live.’

Positive message

So what is his advice to other CCGs and GPs interested in seven-day working and record-sharing?

‘To be positive about it. I think we can do this. In fact we have to do it because otherwise the NHS is not sustainable, so we have to manage urgent care activity, particularly out of hospital and in primary and community care. We are just one of a few pilot sites trying out different ways to do it and time will tell whether that works.

‘But be positive because actually the alternative is very much more scary than anything else.’

And with that Dr Benett has to leave –to take his message to Whitehall.

Quickfire Q&A

Was the Health and Social Care Act good or bad for the NHS?

The health reforms offer the opportunity to invest in and develop primary care; however, they sometimes enforce the introduction of the market and non-NHS providers into health provision.

How did you vote in the last election, and how will you vote in the next?

I didn’t vote in the last election, and voted for myself in the previous one. My politics are more naturally of the left.

If you were health secretary for a day, what would you do?

I would complete the task of nationalising the health service, relieving GPs and others of the bureaucratic burden of independent contractor status.

How many Saturday and Sundays have you worked in the past three months?

I have not done face-to-face consultations at weekends for about 10 years, but am working as I write this on a Saturday.

If you weren’t a GP, what would you be?

A popstar, then a writer or poet –after my parallel career as a box-to-box midfielder with Manchester United.

Readers' comments (20)

  • Ivan Benett

    The wrokforce question is a good challenge and reasonable to ask. I have responded elsewhere to it. We need a 5 year plan, but I agree we need more people in Primary care and fewer in hospitals. Resources will come from reduced activity in secondary care. About 1 deflection from A&E attendance per day (on average) per practice, and one avoided admission per week per practice. In Central Manchester that means about £3M which is enough to fund the changes AND more.
    Disruption to family life need not happen. We don't need every GP, or even every practice to open the extended hours. It's one practice per 8-9 practices acting as a hub for the others. It's 6-8 pm at weekdays and 3 hours on Saturday & Sunday. So far we've had no problem getting GPs to fill the slots. Eventually we need the whole ancilliary staff to be there. Using EMIS web we can see patients notes and transfer infomation back to them. Please see other responses for more detail or email me - ivan.benett@nhs.net if you are still not clear or want more info. We will be able to evaluate progress so far after another couple ofmonths, but I don't envisage full effect until about a year or two.

    Unsuitable or offensive? Report this comment

  • Dear Ivan. Sorry to say that you are just one of the many pseudo-politician GPs who seem to have lost touch with the reality on ground level dreaming of all the services that 'could' be delivered in primary care of course at all hours.
    We have indeed provided way to much of this additional work for too long and this is why we are in the disastrous state we are in at present.
    As a 'left-leaning' CCG clinical director you should realise this and commission Bob Crow to make sure we are paid for the work we do. That is the ONLY way to keep the NHS sustainable - by supporting General Practice not by raising dangerous and unrealistic expectations. By the way, never use the expression 'passionately believe' - this makes you sound like Tony Blair and tops the BS charts ever since.

    Unsuitable or offensive? Report this comment

  • I'm glad you agree the need to more GPs and more nurses because I am not sure how, with the current shortfall in staff, this is going to be workable. We have dropped a partner recently and can't replace. Now we need to federate and then possibly contribute towards the extended hours as a potential hub and see other patients from other practices? I'm not sure where the extra time will come from to see the patients as we are all working on paperwork and going on visits even kerb the normal working day. If we had more GPs of maybe ANP this could be workable.
    I really do accept the need for more patient contact to happen in primary care. I am passionate myself about GP but at the moment I look to the future with. Heavy heart. GP training applicants down 15pc. From those that I talk to GP is becoming more and more unpopular. We are simply not well funded enough to provide the kind of care needed to cut hospital admissions. If we charged by patient contact like secondary care then I see no issues, we would all be fine. However, the current contract covers three patient contacts per patient per year. We all know this is simply not enough. We also know the new contract doesn't pump any more money in in real terms. It's simply recycled money. Taken fr QoF work we will still likely do anyway as it's good practice, and now available only for extra work we need to do to manage at risk vulnerable patients and those at risk of hospital admission. I am a young GP. I consider myself forward thinking and good at what I do. I am settled where I am and lookingto make roots. I am the kind of GP that this country needs to stay put. To continue to deliver exception care, that's exceptionally good value for money, especially at the moment. Yet many friends have left and earn twice what I earn in other countries. Of course the thought has crossed my mind, but why should I even consider this? I want to work in the NHS and want to see it survive. Sustainability though, should not be solely the responsibility of the GPs and if we are I be relied on then we need to be adequately paid for with a reasonable slice of the NHS budget , so more than 8.4%.

    Unsuitable or offensive? Report this comment

  • Hi James. You are clearly an enthusiastic, realistic and competent young GP. We used to call GPs like you 'Partnership Material' .
    Quite frankly, you're f....d.
    If I was you I would do what's be best for you and your future family and leave the NHS like your friends, not for the money but for your own health and job satisfaction.
    Don't fool yourself, Over here things are going to get worse for the foreseeable future.
    Saying that, NHS General Practice desperately needs a generation of martyrs but for your own sake I hope you are not going to be one of them.

    Unsuitable or offensive? Report this comment

  • Edoardo Cervoni

    I suspect there is no way NHS may do without politics. In fact, it is a political choice to have a public healthcare system. Politicians have allured healthcare workers, GPs in particular, and they have been allured by private providers. There is no suprise there, But I find concerning that the NHS, as a public company, yet still a company, to survive it should have the stength of making hard choices. A company that tries to be the lowest cost and highest services enterprise and to do this for all customers segments, it will end up stuck in the middle. It will end up bad in everything.

    Unsuitable or offensive? Report this comment

  • Agree to the issues of the resources to fund GP out-of-hour and the recruitment. To open every GP practice in out-of-hour will be 'a waste of resource'. There are already real GPs there working in OOH in local hospitals, if a health condition is urgent. If it is not, there is open surgery everyday for access or advanced booking to deal with the conditions during working week.

    It's not only a matter of money to fund but also that of human rights, patient safety issues due to doctors extended working hours. Long hours during the week have already been exhaustive, a lot have families and child care duties, exactly, if two in a household work and weekend working is rolled out. GPs are just everyone else in the society deserve human rights on family lives and being recharged in out-of-hours.

    Unsuitable or offensive? Report this comment

  • Customer orientation is appreciated however it is not 'blind', otherwise any company will get lost, end up bad on everything, true.

    Unsuitable or offensive? Report this comment

  • I wonder how many patients have suffered very serious health problems because their GP surgery was not open at the weekend compared to how many patients die waiting for OPD appointments because hospital clinics work 'office hours' or that private surgery is hospital facilities is being done so other patients have to wait?

    GP bashing has become the latest craze!

    Unsuitable or offensive? Report this comment

  • We already have out of hours covering weekends and weekdays, so having regular GPs covering weekends - wouldn't it be just duplication and extra strain on resources. And things have changed since 2002 and expectation of new GPs have changed. Having GPs work in shifts during the whole week would be going the A&E way and I have just read article in BBC about A&E staff moving to places like Australia !
    So we need to be mindful how much we can push GPs. Also considering the GP recruitment crisis, high failure rate for IMGs in GP training - do we have enough GPs to staff weekends and also staff out of hours services as well !!

    Unsuitable or offensive? Report this comment

  • Are you sure that's not Dr Collins from Maghera?.

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page

Have your say