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Gold, incentives and meh

RCGP: Seven-day general practice could cost 'over £1bn per year'

The RCGP has claimed that plans for a seven-day GP service could cost the Government more than £1bn a year, despite ministers only pledging a one-off payment of £150m for the scheme.

RCGP chair Dr Maureen Baker said that a piece of work by Deloitte, commissioned by the RCGP, found that opening just a quarter of GP practices 12 hours a day, seven days a week would cost £749m per year, rising to £1.2bn if that was half of practices.

Also speaking at the Westminster Health Forum conference on seven-day NHS today in London, an LMC leader warned that routine weekday access in their area had suffered due to the seven-day access pilot.

At the same event, a member of the House of Commons Health Committee announced health secretary Jeremy Hunt will appear before the committee to explain the plans behind the seven-day service.

Dr Baker called for clarity from the Government on the costs of the scheme.

The Prime Minister’s ‘Challenge Fund’ committed £150m for pilot schemes to provide seven-day GP services, focused on hubs of practices rather than in all practices.

But Dr Baker said that these resources would only ‘plug the gaps’ but ‘will certainly not provide us with enough resources to open surgeries in England 8am-8pm, seven days a week for fully routine care’.

She added: ‘Independent research commissioned by us into the realistic costs of extending GP hours found that if one in four surgeries opened 12 hours a day, seven days a week it would cost at least £749m per year, rising to £1.2bn if that was one in two practices.

‘Contrast this with the limited one-off funding of £150m for extended hours provided through the GP Challenge Fund and you see the sort of gap we are talking about.’

Dr Baker said the Government should instead focus to ‘really develop the good work that is already taking place under the 10-point plan for GP workforce’ that it worked up with RCGP and BMA earlier this year.

Speaking at the same conference, several other GPs said a lack of GPs made seven-day routine general practice impossible.

Hertfordshire and Bedfordshire LMC chief executive Dr Peter Graves said the Challenge Fund pilot in Watford - which, Pulse has reported, has already cut down Sunday appointments - has struggled to fill shifts both in the extended hours and the regular working week since its launch.

He said: ‘I understand that there were some significant difficulties in maintaining the enthusiasm of the young GPs, meaning the old laggards like myself had to pick up to run the service, meaning that there was some significant impact in the normal 8am until 6.30pm service in their practices.’

Chairing part of today’s conference, Labour MP Liz McInnes, a new member on the House of Commons Health Committee, said the committee has called health secretary Jeremy Hunt as a witness in this parliamentary session and are planning to quiz him for ‘clarity’ on what the Government is trying to achieve and whether their seven-day plans are they right way forward.

The Government has said it will spend an extra £8bn a year on the NHS by 2020 but this is only plugging the estimated budget gap with current service provision and a 2-3% annual efficiency saving, as outlined in the NHS Five Year Forward View, and does not account for rolling out seven day opening.

Readers' comments (19)

  • But no one states the blindingly obvious. A new model needs to be proposed. The NHS as much as you can eat led by dishonest clown politicians is a failing model. The RCGP and BMA need to propose co-payments and insurance like the rest of the world before its too late!

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  • Ivan Benett

    Get with the Programme guys (and girls), this needs to happen if we are to get more investment into Primary Care. No one is going to give us more money for doing the same, however cross the anonymous people get who comment here during the small hours.
    We need to improve in hours access (e.g. using Primary Care Foundation methods or King Kanute approaches), increase capacity and extend hours. These will improve access and continuity. There's a chicken and egg situation, but if we see it as incremental change in that direction then you will see more people wanting to be GPs and greater investment to provide a consistent, extended offer to our population.
    By the way the Deloitte estimate is wildly exaggerated and based on each practice opening for extended hours, and for 7 days a week, which is clearly not possible or needed. A hub based model for an extra 2-3 hours per day, including weekends, can be provided for an extra £3 per patient. This reduces A&E attendances. Unplanned admission reduction needs much more and it needs to be a whole system change, as some of the Vanguard sites are trying to achieve.

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  • Ivan is 100% right ...

    if you want to keep the NHS going with falling real term funds and without tackling the quality of demand i.e. just merely pandering to it then real sacrifices have to be made. Drastic changes to the current care provision have to be made, more real term pay cuts need to be made and expect increased hours for the same/less pay.

    However, if you are no longer bothered about the NHS then the other option is to convert to private practice and charge directly.

    Basically two simple choices.

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  • Ivan. When did you last yourself " what if I am wrong?". I have just finished a Saturday night OOH shift. 80% of if was complete BS. You could open 25 hours a day and still the numptys would come demanding a free pregnancy test coz Darren didn't wear a condom, or some more of that nice cream for my eczema at 8pm on a Saturday night. We are not Tesco, but it's what you will turn us into. Except there are no tills. Your absolute conviction that everyone else is wrong (and you are very definitely in a minority) is positively delusional, scary, and now beyond parody. If you want to jump off a cliff, don't take us all with you.

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  • Easy access stokes demand, work expands to fill a vacuum, and and if anything is free people will take more than they need. These things are obvious to most children.

    Ivan thinks he can solve these problems. He is wrong and will be proved to be wrong.

    But what do I care? I retired yesterday. I just can't be fecked with this job anymore. That was the opening line of my resignation.

    I might apply to be a Corbyn speechwriter. Might be a laugh.

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  • Outrage to agree to 1 billion waste for idiotic medically unnecessary 7 day fragmented routine care encouraging more wasteful Dr dependency...and damaging continuity of care..a ludicrous duplication that for good reason exists in no other health system....worse in a collapsing primary care to start this waste is inexplicable irresponsible doctrinaire insanity
    why does Ivan persist with the weak idea that this wasteful nonsense that will take money away from front line care is the way to get more money into primary care... no the truth is existing funding will be taken away and moved into this absurd scheme ...how naive
    Time to confront this demagogic madness

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  • Ivan demonstrates the same weakness as many of the NHSE managers, they've often been to a few management days or had talks with a management consultancy group and then spend the next year repeating the consultants fave mantra - 'working at scale', or one of a dozen others.

    Just simple logical thought is often enough to destroy their models.. Where business strategy is useful is where it takes place with proper critical testing - happens a lot in Pharma and IT. And unsurprisingly it still goes disastrously wrong some of the time.

    I accept in the NHS - history says be first to jump on the bandwagon regardless of logic and consequences - grap what you can until the next fad comes along. i imagine this is what Ivan is doing and fair enough.

    Bit of a shame though.

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  • I love it when Ivan comments.

    As soon as I see his pic a smile appears on my face because I know what's coming.

    I don't think I've ever seen a poster on these forums that sticks so doggedly to his convictions.

    Part of what he writes is correct. The government will never give more for less. Or even more for the same. They will only give more, for a lot more from professionals. Perhaps where Ivan works his approach is correct, I'm not a Manchester doctor so I can't speak from where he comes. I know certainly that not too far away in the midlands we have extended in hours clinics, we have sit and waits for anyone who wants to be seen, everyday we have a telephone triage from 8:30 until 6:30 so that anyone who needs to be seen urgently can do so. Outside of these hours we have a robust out of hours service. I really don't know what more that we personally can do to keep this incessant demand in check.

    Open even longer? Offer even more appointments?? Most of the time it will just end up with even more of the usual nonsense?

    Does the above ring true with anyone else here????????

    WHAT MORE CAN ONE DO?????

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  • Deckchairs and titanic come to mind.

    All this talk is a bit silly. The NHS (general practice) is on the verge of collapse. That collapse is now inevitable. The numbers leaving are greater than the numbers coming into the speciality. The population is growing.
    Medical students all realise that the speciality is in its death throes. They wouldn't touch it with a barge pole.
    The injection of cash that happened in 2004 is not going to happen.
    The practices run by LHBs are increasing by the week. The locum pool is drained. It soon won't matter how much they offer they simply will not be able to staff the practices.

    So what do we do.

    Firstly ignore all this talk about 7 day working its just not going to happen. Don't waste your breath / typing.

    Some of us will be able to emigrate, some of us will be able to retire there will be some of us that will be stuck here.

    So how do we protect ourselves? Start the planning. How to remove yourself from the NHS. How much you could charge patients and keep the doors open. How will you transition into private practice? What IT you will need, what staff you will need, what banking facility you will need, can you keep your premises or will you need to look for a new place to work.
    Speak to dental colleagues they have already been through this.
    Do the planning if I'm wrong you've lost a few hours and you'll be entering the promised land of 7 day working.

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