In our area in Hertfordshire, practices have been offering 8am-8pm appointments, seven days a week, on a rotating ‘hub’ basis.
For example, if a GP surgery was normally open until 6.30pm in the week and one of their GPs was on rota that day, they would stay open until 8pm.
Shifts were filled easily at the start when the pay rates were high, but not when pay was reduced.
Routine GP appointments on Sundays were not popular, so have been drastically reduced. Sundays are quite popular for phlebotomy, though.
Our Challenge Fund pilot has not led to a reduction in A&E activity and it has, some GPs tell me, hampered continuity of care. Some patients are seeking a second opinion from their regular GP after visiting a hub practice.
GPs have also struggled with IT during the pilot as they were not able to enter information directly onto clinical systems of other practices. So when GPs need to refer patients not on their own list, duplication occurs in the system.
Although patient reviews have been positive, with 98% saying they would recommend the hub service, increasing patient expectations via pilots like this is not helpful in a cash-strapped NHS.
Our local pilot evaluation showed more than half of patients would have just waited for a routine appointment if they had not had this service, indicating that they went for convenience only.
I see continuity as an integral part of routine general practice and for urgent problems there is an out-of-hours GP service, which is excellent locally. It is known that disruption in continuity affects cancer diagnoses, something in which the NHS lags behind Europe.
Dr Sara Khan is vice-chair of Hertfordshire LMC and edits the Medical Women’s Federation’s magazine, Medical Woman
