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Gold, incentives and meh

GPs told to prepare for 'Tesco-style' seven-day opening

GPs should be prepared to work at weekends for the benefit of patients in an effort to emulate the customer service offered by Tesco, the medical director of the NHS Commissioning Board has said

Sir Bruce Keogh told the Sunday Times that primary and secondary care clinicians should move towards seven-day working. He said the current system is designed for health workers and not patients.

‘Our system has been based around providing as good a working environment as you can for the people who work in the health service, which isn’t necessarily matched with what the people who want services have. If you wanted a day case operation, and you didn’t want to take a day off work, why can’t you have it on a Saturday or Sunday?,’ he said.

‘It seems strange in a way that you cannot go to a clinic at the weekend, you cannot have your day case surgery at the weekend when the rest of the commercial world is going in a different direction.

‘Tesco have had to go through this – it was a complex issue for them. As we think this through, we will need to look at the terms and conditions of service of people – employment conditions.’

A BMA spokesperson said: ‘The health service is not Tesco — I don’t think that is a good comparison. Equally, there are examples around the country where clinics are taking place at weekends.’

She added: ‘The BMA is open to discussing seven-day working. The key issue is flexibility — not all clinics will need [weekend opening].’

Readers' comments (62)

  • Tesco did it not for the good of the people, but for profit.
    I work to help others.
    Yet another kick from a goverment whose priority is votes rather than sense.
    Mao Tse Tung, had a similar ethic- constant revolution and change to confuse the masses and cause constant anxiety.

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  • Is that why the extended hours DES is stopping and does that mean that Tesco is now free at the point of service?

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  • The Tesco model could work. Patients could stand in long queues in warehouses and scan themeselves. If that doesn't work they could join even longer queues to see someone on a minimum wage who can do the scanning for them. What could possibly be wrong with that?

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  • are these people living in the real world?

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  • There is a clear agenda to privatise NHS ASAP - decisions are clearly being made contrary to the white paper, this has never been a bottom up exercise, pure dictatorship. We are losing a lot of GP workforce to Australia/NZ and this is eventually lead to poor quality

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  • NHS is not free. We are paying for the service through our taxes!!!

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  • Given the mauling GP's have had on Pay, Pensions and fresh on the heels of the latest QOF imposition the BMA should be screaming that enough is enough but instead we are told that they are open to discussing a 7 day week.

    We should not contemplate any discussion until such time as the DOH addresses our other grievances.

    I am afraid that the BMA gives every impression of being happy to go along with the destruction of Primary Care.

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  • He refers to "the rest of the commercial world". The NHS is not the commercial world - though that's the clear aim of the English NHS. Tesco's - long queues and lowest wages it can get away with. Is that a good model to aspire to for healthcare?

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  • Hazel Drury

    You really shouldn't be taking just 1 day off for any "day case surgery" ! You think that day case means 1 day recovery too?? Meanwhile, on planet Earth......

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  • Our system has been based around providing as good a working environment as you can for the people who work in the health service, which isn’t necessarily matched with what the people who want services have. If you wanted a day case operation, and you didn’t want to take a day off work, why can’t you have it on a Saturday or Sunday?,’ he said.
    xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
    Oh I see now Sir Bruce. All patients who have day case surgery go back to work next day therefore if they have their op at the weekend they won't miss any work at all ( unless they work in Tescos of course).

    Thank goodness I retire soon.

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  • European working time directive! As long as we are part of the EU, we wont be working a 7 day week. Never going to happen , no need to get upset about these comments.

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  • Harry Longman

    Why oh why did the previous government chuck away the GPs 24 hour responsibility for patients? Doctor-patient relations converted into transactions. They can never be the same.
    Now DH wants it back, but again the thinking is all numbers, and Tesco analogies will not help. They are perfectly happy with transactions after all - it's a shop.

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  • Let common sense prevail

    I am quite prepared to open the surgery for 7 days, but clearly I will need more GP's and more staff. To go from a 5 days service to a 7 day service it would seem reasonable to expect a 40% uplift in pay. As soon as that is agreed I'll get on with it!!!!!!

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  • David

    It would require an increase in funding if more appointments are to be offered rather than the same number spread over 7 days not 5. But it wont increase pay as each employee would still work 5 out of 7 days, or there would be some form of shift pattern, just as there is for junior doctors and nurses i the acute setting.

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  • The Tesco comparison was unwise but there is a serious point about access to primary care for the working population. It's obvious that the system does very little to cater for the working masses, not every boss will allow you to take time off to see a GP. Why shouldn't GPs work shifts if this best serves patient needs?

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  • I don't mind organizing 7 day surgery as long as there is adequate funding - on a simplistic scale, we'll need to multiply our per capita payments and correction factor (any whatever form it may exist) by 9/7th (2 more days of the week) and 1.5 (extra payment for unsociable hours).

    Will DoH afford such expense? I doubt it. They'll try and make us do it for nothing........

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  • Vinci Ho

    Editor , will you interview Dr Gareda on this matter?
    I think many people are interested in her opinions ?

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  • I am baffled...what next - GPs/consulatants working 24/7!! If Prof Keohg is willing to be availabel to the pubilc and his team 24/7, 7/7, I will be happy to do so.
    I can see mass exodus of older GPs showing the Victory sign to the Govt/public

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  • a fine comedian.really made me laugh.

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  • Nhsfatcat

    The way of the world is that value is measured in money and demand and more demand for service.
    If my children's schools open on Saturday and Sunday I can come to work; or am I as a GP going to sacrifice my family life and give up my volunteer weekend work to be a slave to HMGs drive for votes.
    Get a grip people start valuing healthcare, the people who provide it and services as they should be. Not in monatary terms but as a precious resourse.
    As for the fallout position of 'I pay my taxes' I do not think people ahve a scooby about how much is provided for so little. One day the goodwill and vocation to be a healthcare worker will be consumed by a monatary value being put on it and when it does the customer will be in more pain having to pay the true costs or what the commercial medical world will demand. PLEASE look across the Atlantic and see what we are heading for. Stop believing all the bad news via the Dailies and HMG their agenda is not patient centred, it's profit centred.

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  • I disagree - I think the current system is based (and funded) around routine Monday-Friday normal hours and an emergency service at weekends, not primarily to provide a good working environment as asserted. Moreover, if everybody is expected to work 7 days a week, the argument for having surgery on Saturday or Sunday so as not to miss a day's work becomes illogical.
    This is not the commercial world - it's healthcare. If routine 24 hour care is desired, it will have to be funded and staffed. On the other hand, money could be saved (in these times of austerity) by retaining the current system and - hey - actually taking time off work to attend to one's health. The occasional inconvenience is surely better than mass disruption, cost and likely increased recruitment difficulties.
    Tesco - what on earth has the NHS to do with Tesco? (And why the free advertising?)

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  • I've seen lots of comments about how this isnt extra work because that which comes in during the week will come in at weekends instead. Workload will increase disproportionately at the weekends as the mildly inconvenient break is released. The WHOLE system would have to be working at weekends to support adding to the 300 million per annum primary care appointments already delivered. Tescos and Sainsburies should still to selling Fruit and Veg and Lord Darzi and Sir Bruce should stick to surgery. I doubt either know the first thing about primary care having not qualified in the specialty.

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  • Will this mean I can get Tesco club card point every time I see my GP. Happy days!

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  • Not just tosh, not even utter tosh this is utter utter tosh!

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  • The road is paved for companies to run the NHS , eg, virgin, , UK care , ......otherwise you have to do it.

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  • Peter Swinyard

    OK, so I open my surgery on Saturday and Sunday. Now, it so happens my children are all grown up and my wife does not work due to her health - so I could do this. But it is antisocial hours, which command a premium in any service sector, and I shall not be open on Monday or Tuesday if I am open at the weekend. And I expect a lot of extra resources for this - my staff will not work at weekends. Full stop. They just won't. Not even for money - they have families and husbands who work 5 or 6 day weeks. When I used to open on Saturday mornings, we had great difficulty staffing this. Would require ridiculous amounts of money to make this happen. Prof Keogh - please listen to me as I have always found you a reasonable man when I have met you, THERE IS NO MONEY to do this. The days of proligacy from the last government are OVER. Surely there are better things to invest in even if we had the money. If you ask patients the question "would you like your GP to be open at the weekend?" the answer is yes. If you ask the question "Would you like your GP to be open at the weekend instead of in the week?" the answer may be different. And don't talk to me of efficiency savings. As aprevious comment says, Tosh, tosh and more tosh. And he/she was being VERY polite. Scotch this, put it away and let's talk about something good for patients...

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  • Important for GPs to get on the right side of the argument here...
    1. It is indefensible that hospitals work so badly at weekends with worse mortality rates
    2. It is indefensible that community and social care services, plus lack of consultant rounds mean levels of discharges plummet at weekends so hospitals are in meltdown on Monday's.
    3. It is an opportunity missed to avo

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  • There is commercial gain to open 7 days a week by Tesco!
    There are just added costs in the NHS
    So the question is how do you pay for it ?
    If you want it like Tesco ... Pay per case???
    I don't think so !!
    Gp 's should deliver what ever is commissioned
    But we should not be expected to do it for free?

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  • Who is going to pay for this 40% increase in capacity? 40% more referrals, 40% more surgery - all to be provided by hospitals who have their income capped. This suggestion is either stupid or devious - softening up the public for privatisation. Probably both.

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  • 'It is indefensible that hospitals work so badly at weekends with worse mortality rates'

    The hospital is working. The consultant is not. They dont even start their clinics or surgery on time 5 days per week. Good luck with getting them in at the weekend.

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  • "it wont increase pay as each employee would still work 5 out of 7 days"

    Just a 40% increase in workforce required then (doh!) - whom I suspect probably won't work for free, so the cost goes up by more than 40% because it's not a marginal cost.

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  • Amazing- how long before weekends and holidays vanish altogether for everyone in the name of working off the debt of fiat currency generated by bankers and politicians who work how many hours a year?

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  • Mark Struthers

    GPs have proved themselves highly adept at selling quack remedies like flu vaccines, statins and all manner of useless QOF-drops. I can understand why Sir Bruce equates the health business with Tescos.

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  • This article has generated the expected negative comments, but just look at it from the patient's perspective the rest of the world operates a 24 hour system why should routine medical care be limited to weekdays?
    The idea should be encouraged the real battle should be to get appropriate funding for this

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  • Increased cost, increased abuse, lack of appreciation....the government needs to spend time and effort educating people as to the appropriate use of health services, and if it is abused, charge accordingly. 7-day access just creates unnecessary demand. Articles in the Times about the unnecessary prescribing of amoxicillin....great.......but sometimes we are so cornered by the aggressive, abusive and complaint-threatening patients, what other options are there?!?! Unless we stand our ground, but then they try to see another GP or go to an urgent care centre where it is easier to prescribe and get them out the door!

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  • I think that this devalues the health service enormously. The goivernment should support industry and people to prioritise health by enabling them to attend genuine GP appointments and to take some responsibility for their own health. There is an enormous amount of people who call GP surgeries for an emergency appointment but can't take up the appt they are offered because they are busy elsewhere!!!

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  • If someone is ill, they are more than likely to be off work and so could come to the doctors during the week. If they need to come for a routine check and are not ill then surely that is why we currently operate extended hours!
    Where I work, there is a good out of hours service that covers overnight and weekends, and also operates the '111' service, so emergency and general health advice are catered for.
    Having to open at weekends will involve so much extra funding that it won't be affordable. Unless extra GPs are employed, it will mean a dilution of availability during the week, not to mention having to employ additional staff and paying unsocial pay rates. There is no way we could spread our existing staffing over an extra couple of days.
    A high proportion of patients attending the surgery are elderly, or at least past retirement age, so they should have little problem attending Monday to Friday without having to beg any employer for time off.
    I can see this appearing in the media as "GPs refuse to work weekends" getting the profession more bad publicity. The BMA need to take a very firm stance on this and ensure that if it does happen then it is properly funded and not done on the cheap like most of the initiatives over the past few years.

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  • If a full GP weekend service is really that important to meet the unmet health needs of those who work AND resources are limited then the solution is to be open for 3 weekdays (for the non working population) and open at the weekend (for access to those who are workers only).

    It may not be popular with those who work in GP Practices BUT if it is truly important to meet the unmet health needs of workers then so be it.

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  • Thats a very brilliant idea, why not 24/7 and all the government offices and including Sir Bruce Keogh working 7 days of the week, life would be so convenient.
    I am surprised he is medical director of the NHS Commissioning Board.

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  • What about alternatives;
    • Close the UK borders forthwith we cannot support any more people - works in Australia!
    • Stop providing free healthcare to literally anyone irrespective of their right to be here
    • Make a law saying that Employers MUST allow employees to visit their Doctor subject to a "certificate of need" from GP
    • Stop politicising the NHS - tell the truth, Patients are routinely abusing it - you DO NOT need to be seen with a cough after 2 days, fungal nail infections are not an emergency
    • Stop prescribing any drug that costs less in any Tesco (Other supermarkets are also available) than it does for the Doctor to issue, print, the pharmacy to fulfill & claim the PPA to validate & reimburse EG Paracetamol 18p to buy £20+ cost of a script?

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  • In our area/county/region we have a GP recruitment crisis, so whoopee, another reason why doctors won't want to work in general practice.

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  • He must be a very silly man if he is being reported accurately.

    Stretch the present resources to a seven day week with infinite hours is possible but how many GPs would suffer from burnout and how many patients would die though mistakes due to fatigue?

    How many hours a week does he think a GP should work?

    With more GPs and resources what he suggests is possible..

    With no more resources his statements if true border on idiocy.

    You could have lay people with check lists and all combinations up to a fully qualified GP in a hierarchical system but even that would require more resources.

    Surely he must have been misreported other wise he is a seriously flawed thinker.

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  • Most healthcare is routine and much of it complex. Some healthcare is urgent and much of it straightforward.
    Continuity of care is essential for safety and efficiency. 24/7 or 7/7 General Practice will risks undermining this.

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  • My late evening surgeries are already full of the same old pensioners and dossers I see all day long, and are an imposition on my family life. If I could truly reserve the slots I make available for the working population who can't get to see me in office hours I wouldn't even need to consider extending the free-for-all into what remains of my own time ie the weekend.

    I already get complaints from patients I see out of hours when they have to reattend in hours for the bloods etc I want them to have. Is the government going to pay for all the backup services I need to function as a GP or do they still believe life is as simple as patient sees doctor gets script end of?

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  • Anyone over 55 will be off into the wild blue yonder! This is more nonsense. This political push to a 24hr society is destroying family life.It is a downward spiral which I fear we cannot reverse.The joke of it is we are all being forced to cater for those work work 9-5-the ultimate end is that they will be an extinct species as everyone will be working ridiculous shifts to keep everything available 24/7!! We cant afford what we have so why keep offering more and creating ever greater expectations.Lets hope this idiot doesnt waste as much money as Lord Darzi did on stupid ideas.

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  • Side by side with this idea is the premise that nurses and protocols can deal with most routine care & paramedics and protocols most emergency care so there will be the expectation of reduced costs as the GP workforce are diminished.
    Then of corse there will be a further downward pressure on costs as with diminishing GP posts will be an increasing redundant workforce competing for the few remaining posts .. And with rules of supply & demand, if supply of workers is high the remuneration will fall.

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  • I used to blame the BMA, but really what are we prepared to do? Seriously, our pay per face to face consultation is now £3- £4. If we continue to work so cheaply, we will get more thrown at us. Are we prepared to walk away? Otherwise, we may button up and just work.

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  • Siraj Shah

    What amazes me why we cannot unite and stand up against these politically driven and financially motivated foolish reforms ? As long as we lack a strong leadership and our trade organization BMA behaves like a toothless tiger...the future of General Practice looks bleak.

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  • ‘Tesco have had to go through this – it was a complex issue for them. As we think this through, we will need to look at the terms and conditions of service of people – employment conditions.’

    i would strongly suggest you do this first Sir Bruce ....before you make any more foolish suggestions.

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  • I think we need some compromise. My daughter's friend has to take a day's leave just to see her GP for a medication review.

    I have also just been shouted out by my employing GP for asking if they have realised they have left their practice nurse (me) working with no GP half the afternoon. Among other issues, I only got to mention the lack of someone to sign a prescription (since he didn't approve the course), only to be told "Let them come back!" In this instance, this GP is totally unsympathetic to people taking time off work to actually get to the surgery, some elderly frail pay for a taxi...well I know some of you must understand!

    To try to compromise I start work at the surgery 7am two days a week and the bonus is I miss the traffic jams. However, I prefer to keep my week-ends for my own family.

    At least my non-nursing degree might get me a management job at Tesco :-)

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