Here we go again. The First Minister for Wales has stated that GP surgeries will be open on Saturday mornings from 2014, and that BMA Wales – which has criticised the move – is out of touch with the profession.
Why does the First Minister and his team think this is going to be of value to Welsh patients? Where is the evidence that this is needed by the majority of the citizens in Wales? Where is the economic argument to support this policy, and is this the wisest use of scarce resources in the current climate?
Additional hours of work mean additional investment. There is a perfectly good directed enhanced service for Saturday openings that can be used by the local health boards, but even they lack the enthusiasm to deliver this. The boards know that resources could – and should – be used elsewhere for patient care.
At the moment, GPs work tirelessly over long days running from 8am to 6.30pm. Consultations are more complex, there is an increased disease burden in Wales – with an ageing population and patients often having multiple co-morbidities – and ever-increasing work moving into primary care. GPs are already stretched to breaking point. Stress in the profession is at an all-time high and morale is low. At a time when the Welsh Government needs GPs to deliver on their key strategic policy, Setting the Direction, angering the profession is not a sensible move. Nor will it help with recruitment and retention of GPs in Wales – an issue that is becoming increasingly important.
I undertook a straw poll of 70 colleagues, and not one felt this was the direction we should take. It was a 100% ‘No' vote – a fairly clear message, then, that GPs don't want to open on Saturdays. I also asked a surgery of patients (45 for me on this particular day) – and just seven said they might use a Saturday surgery. Interestingly, these were all elderly patients to whom this service isn't being targeted. The rest said they preferred to spend their weekends relaxing.
It has further been suggested that out-of-hours organisations might want to deliver these Saturday surgeries, but the supposed purpose of out-of-hours appointments is for routine care. Patients who have difficulty getting to their GP in the working week who want to use the Saturday surgeries need to be treated by clinicians who have access to their full medical record. The individual health record would enable access to most of the important information, but this is not yet available across the whole of Wales and does not yet include access to all parts of the patient record either. While politicians forge ahead with pushing Saturday opening, we are waiting for the individual health record to receive more investment so clinicians can offer holistic care to patients in and out of hours.
There is also the not so simple matter of staffing this additional workload for out-of-hours appointments. All providers across Wales have struggled to staff shifts at times, because the pool of GPs who do out-of-hours work is a finite resource. Even in my area, where we have a significant investment of local GPs in the service, it is getting increasingly difficult to staff additional new work, as the local health board continues to look to GPs to support other aspects of service delivery.
I would like to know where these GPs are who want to do Saturday shifts – because I can't find them. Welsh out-of-hours providers would welcome these GPs into their organisations with open arms – we are always looking for keen and enthusiastic local GPs. Saturday mornings are also typically the busiest day of the week for out-of-hours providers. The health minister's proposition runs the risk of destabilising current out-of-hours services – surely this is neither reasonable nor acceptable to the people of Wales.
Who really is going to benefit from Saturday opening? A cynic might say it will only be the politicians. Is the Welsh Government really going to try to impose this on GP practices? They might try to, but I can assure my colleagues that GPC Wales has absolutely no intention of revising our stance on Saturday mornings – or, indeed, in renegotiating any part of core hours in the UK GMS contract.
The Welsh Government needs to wake up and smell the coffee. They must think about what is right and best for the population. We have scarce resources and we need to use these wisely.
GPC Wales welcomes challenges on the issues where there is evidence GPs can make a difference to patient care. But this is not one of these issues.
Dr Charlotte Jones is a GP in Swansea and deputychair of GPC Wales
