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

GP opening hours to be included in NHS review of urgent and emergency care

GP practice opening hours are to come under scrutiny as part of a national review of urgent and emergency care being launched by the NHS Commissioning Board.

The review - which forms part of plans to introduce more seven-day working across the NHS in England - will be led by the Board’s medical director Sir Bruce Keogh.

Sir Bruce recently told the Sunday Times that GPs should be prepared to work at weekends for the benefit of patients in an effort to emulate the customer service offered by Tesco.

He said that primary and secondary care clinicians should move towards seven-day working as the current system is designed for health workers and not patients.

In a statement the NHS Commissioning Board said the urgent and emergency services review team will work with CCGs to develop a national framework offer to help them ensure high-quality, consistent standards of care across the country.

It said the review will take account of the way that emergency care in England works with other areas of the NHS, such as GP surgeries, community care and the 24-hour NHS 111 advice line.

A Board spokesman confirmed to Pulse that the review team would examine the whole NHS - including GP surgeries and out-of-hours care.

The review team will publish emerging principles for consultation in the Spring.

In its planning guidance, published late last year, the NHSCB said it would order the review as part of plans for more seven-day services.

As well as seven-day working, the review aims to help CCGs find “the right balance between providing excellent clinical care in serious complex emergencies and maintaining or improving local access to services for less serious problems”.

It will set out the different levels and definitions of emergency care ranging from top-level trauma centres at major hospitals to local accident and emergency departments and facilities providing access to expert nurses and GPs for the treatment of more routine but urgent health problems.

As well as looking at how emergency care is provided, the review will also assess transfer processes between these levels of emergency care.

Launching the review Sir Bruce said: ‘The NHS is there for all of us and should offer appropriate, effective and rapid care whenever and wherever it is needed.

‘Treatments for many common conditions such as heart attacks and strokes have evolved considerably over the last decade and are now best treated in specialist centres. Yet we know people want their A&E nearby.

‘This makes me think we need to review the increasingly complex and fragmented system of urgent and emergency care, so that sick, anxious and often frightened people can get what they need when they need it.’

Readers' comments (19)

  • Oh great they'll be telling me soon:

    "Doctor, your 12 hours a day shift just isn't adequate, you should be working 24/7. By the way take a pay cut whilst you are at it will you....."

    Unsuitable or offensive? Report this comment

  • Good idea but who is going to do it?? I am NOT working 7 days per week. This would need to be resourced direct from the government as extra funding. Does this lazy, pompous and arrogant man work 7 days a week?? "Sir Bruce" can **** ***

    Unsuitable or offensive? Report this comment

  • Primary Care is not Tesco thank god?
    If we didn't have a constant stream of coughs , colds & winter vomiting there would be more than enough appointments in a normal 5 day working week.

    Unsuitable or offensive? Report this comment

  • You want us to be more like Tesco. Does that mean we cut corners to the extent that our care become "horsemeat" too?

    Absolutely consumerist drivel

    Unsuitable or offensive? Report this comment

  • This comment has been moderated

  • My local Asda recently stopped beng open 24 hours!!! Why? Making not enough profit of course. The is no comparison between tesco or asda & the NHS.

    Unsuitable or offensive? Report this comment

  • welcome to 21st century NHS;M Leaving for Australia

    Unsuitable or offensive? Report this comment

  • They took money away from us in return for relinquishing OOH responsibility. Now they realise that the alternatives they put in place are inadequate and want us back!

    Unsuitable or offensive? Report this comment

  • Professional engineers, as well academically qualified as GPs, work shifts, for about half the pay that GPs get, in order to ensure that the lights stay on.

    Why should GPs not do likewise?

    Unsuitable or offensive? Report this comment

  • In response to Terry Jones: your comparison of general practice to engineering is misguided.

    Engineering covers a wide range of professions from electrical or gas engineers to civil engineers... Not all of these are subject to equivalent academic training and professional development as GPs.

    Fixing an electrical fault or a problem with network cabling ( as examples) is not equivalent to health care. Our patients usually have a hierarchy of health concerns. They will usually seek medical advice when they perceive something to be important or serious.

    One patient with a headache will book an appointment fearing a brain tumour another may ignore it as probably nothing yet see the GP for his/her abdominal pain instead.... A patient's health agenda does not go away. Instead their priorities change.

    In the example above once the patient has had their headache assessed they may be reassured and this problem falls to a lower priority. They may then book another appointment to address their abdominal pain.

    This constant shifting of health priorities means that there is an almost infinite demand for GP services.

    This is the reason we cannot thin our service out over the week to a 7 day working schedule... The demand for appointments would not decrease over the weekdays. The very patients seen during the week would create demand for appointments at the weekend with (understandably) new health priorities.

    General practice is stretched to breaking point at present. GPs routinely work 12 or more hours per day and everyone I know is unable to finish the days's work in those hours.

    7 day opening would not reduce the weekday workload and as such would be unworkable. Some commentators have suggested that GPs should simply employ more doctors to create extra staff.

    As many have said already on this site, most GPs do not earn the sums that the daily mail suggests. To cut GP pay further would leave the profession open to market forces... That is future students and graduates will decide that the social/emotional cost of the job (never seeing your family, stress, increasing loss of autonomy and professional independence) does not match the economic benefit (I.e take home pay) and satisfaction derived from the practice of medicine... Recruitment to general practice will dry up and the system will collapse.

    .... Actually, never mind recruiting new GPs, the country may struggle to hold on to the ones it has already!

    Unsuitable or offensive? Report this comment

  • Tesco gets more revenue by opening 7 days a week
    If your cost base increases this has to be met.
    I'm happy to work on any days in the week.
    But not 7 days a week .
    If this is not funded with a fair market profit
    On top... Tesco is allowed to make a profit...
    Then it will not work!
    If you want to change and improve access
    It will not and never be cost neutral .
    We as a nation are struggling with debt .
    So to implement this we have to think out of the
    box.
    New income streams required
    I do not know the answers but what about
    Considering
    1....charging insurance companies for all rta's
    2....All sports clubs/ individuals having insurance for injuries Nhs bills the insurer
    3.....All employers have to have injury at work
    Insurance

    These are just examples....
    Use the money raised to reinvest in the desired
    Changes???
    In the review lets hope they look to see if the added
    Costs equate to health benefits.. Convenience
    May not be affordable!

    Unsuitable or offensive? Report this comment

  • Spencer Nicholson

    OMG Sir Bruce what are you saying. Let's think about it work 40 hrs a week but need to cover 56 hours for 7days at 8 hours or if he is suggesting 12 hours a day 7 days a week 84 hrs mmmm sounds good. Just the demographic time bomb of approaching retirements and not training enough gp's in the first place seems to leave a great big gap in the workforce to achieve Brucie's aspirations.
    Inflating patients expectations and then saying get the lazy bastards to work harder for less money
    Some recruiting poster!
    Again so bloody glad I am now in Australia!

    Unsuitable or offensive? Report this comment

  • This is what will happen. A review, shortly followed by an imposition from the governement to extend GP core hours. How will this be financed? Nothing extra, you can be sure of that. Pay from one GP revenue stream will be diverted to fund this. If GPs dont reorganise to provide 7day a week care 8am to 8pm, they will therefore receive a pay cut. However it will cost more for staffing, building costs, cleaning etc. Who will finance that? GPs of course. One doesnt have to be a sage to see this coming, just to have worked in the NHS for a few years

    Unsuitable or offensive? Report this comment

  • one point that seems to have been completely missed in all this obsession with TESCO as a great example for the nation is that said Tesco has not done very well in recent years. ? loss of quality? i think so. and the same would beset NHS General Practice as, unless it really was very well rewarded, it will lead to a further erosion of motivation amongst doctors and usage of cheaper staffing solutions.
    it may cover the hours, but you are not going to get the experienced doctors doing them who could really make a difference in terms of patient's use of secondary care resource.
    and to the chap who criticised Terry Jones, very happy to be more equal but it would have to include our friends in management, lawyers and many more...
    all you will achieve is people thinking twice before making GP a career choice and those in it already will look elsewhere

    Unsuitable or offensive? Report this comment

  • It's true that you can shop at Tesco whenever you feel like it, be it 3pm or 3am or whatever.
    However you won't see the same cashier every time you turn up - the one who knows you, and can carry on the conversation you had last time you saw them. Because of course, it wouldn't matter.
    This is not the case with primary care!

    Unsuitable or offensive? Report this comment

  • This doesn't only affect GPs, we'd have to have a nurse and admin staff in too. I can see a mass exodus.

    Unsuitable or offensive? Report this comment

  • I doubt that Sir Bruce Shops at Tesco!

    Unsuitable or offensive? Report this comment

  • 7 day opening is already here - walk in centres that operate in various guises from 8-8 or 10pm and run as GP surgery are already in existence. I know its not for everyone, but i opted for the benefits of some flexible days off during the week vs working a weekend a month, i suspect this is partially the governments idea of what they would like in Gp surgeries. What they probably haven't factored in is the cost of operating 7/7. I see a large number of people through the service who cannot get into to see their regular GP due to no appointments or the hours are not conducive. Gone are the days when people would take time off. From my experience, the only ones in the surgery during current opening hours are the elderly, yound parents and small children and those who don't work too much. Effectively current GP opening hours are missing half the population out.

    Unsuitable or offensive? Report this comment

  • I spoke to somebody in out local Tesco store today they employ 350 staff.

    Unsuitable or offensive? Report this comment

  • I think the Govt. want to spread the work load over seven days to suit the tax payers. Speading the workload loike this will cost extra labour, heating and other semi variable costs.
    Do not be feart girls! The country cannot afford this type of service. The review of urgent care will figure this one out - I assume there are no bright ideas which will prove me wrong!

    Unsuitable or offensive? Report this comment

Have your say