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Analysis: How the Government’s seven-day GP access scheme could work

Dr Ivan Benett describes his experience as clinical director of NHS Central Manchester CCG, whose scheme was hailed by the Government as a prototype

Our overriding ambition is to provide a service for the people of central Manchester that is consistent and of the highest quality.

The first step is to be available when people are ill, or believe themselves to be ill. This means increasing the capacity in primary care to see more people at the times they are able to access the service.

So, our aim is to begin to offer longer opening times by this Christmas to the population of one of our localities – around 50,000 patients. Each locality has about eight practices. The £500,000 scheme will eventually see one practice in each locality open for business from 8am to 8pm on weekdays and for three hours on Saturdays and Sundays. When surgeries are closed people will be seen at this locality hub.  We want people to come to this service rather than go unnecessarily to A&E, especially between 6pm and 8pm. We also aim to be able to match the standards currently delivered by the out-of-hours service for responsiveness to urgent demand.

The extended access scheme will only work if practices can share patient records [between GP practices], after appropriate consent from patients. So that will happen when we start and then we will roll it out more once we learn what the pitfalls are.

In the medium term, once we get the technology working, I would hope that we could progress to sharing electronic patient records with emergency and urgent care services.

We are still working out the financial details but GPs will be paid roughly the usual fee they would have earned under the extended hours DES. No one doubts or underestimates the challenges of resource and workforce capacity, but without timely access the rest will not be possible.

Wouldn’t it be wonderful if in three years’ time outcomes improve, extremes of variation reduce, and all our patients can say ‘I am able to access the health service, at a time that I need it, and am confident of getting the best quality care when that becomes necessary’?

Readers' comments (40)

  • This is a con - the way it was peddled in the media it sounded like 12hrs per day 7 days per week at surgery level for all needs both chronic and acute.

    This is nothing like that.

    The language used to describe it above is utopian and idealist rather than practical. It does not seem embedded in the realities of the present unscheduled access debate and the timelines needed to deal with the issues.

    It's not even that radical. .

    At £500,000 it looks very expensive.

    Sorry - if this is what the future looks like we have even more problems ahead.

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  • what experience??? The scheme hasnt even started yet!! Its just a dream ....soon to turn into a nightmare.

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  • ''The argument is one of self-interest for GP and practices. It is that without responding by increasing availability we are making it easier for the Government to make the case that independent providers deliver this increased availability. If you fear creeping privatisation then you must accept this argument. I have personally stood up against creeping privatisation, and very publically. I remain committed to stopping it happen. I believe by offering extended availability we will cut off this route.''

    This essentially is the fallacy of your argument Ivan. YOU want to ''save the NHS'' . most of the GPs are not bothered even if private providers came in to do the OOH or increase the availability. They will have to be funded well to do the job and then as with OOH GPs can choose to do shifts. Why accept more work without proper funding?? You have no right to expect all GPs to do extra unfunded work by making hare brained schemes.

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  • Do GP's not work hard enough already by providing exceptional working standards and practices as it is?

    Where is this going to lead too, how about re educating patients regarding taking responsibility for their own health and self treating OTC initially.

    Advanced Nurse Practitioners (who are also independent prescribers could be given more sessions and be able to complete more mundane GP tasks like sick notes etc to help providing more sessions if funding was available).

    Lets not Flog the GP's anymore, instead lets support the fantastic work they already provide - at the end of the day, GP's have a life too and not just the patients.

    Give the Out of Hours care back to the GP's and enable them to steer this too rather than all of the Private Organisations and enable the GP's to make the relevant decisions regarding their own Patients!

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  • Shaba Nabi: Observations well made and argued! The only way to make improvement is by employing more doctors.I don't understand why GP leaders only like to grin and bear it all. Also,time given for consultation per patient should be increased to 15minutes.

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  • I would be prepared to do my part but only if the government start really tacklng obesity and alcohol two major reasons reasons why the health services are overloaded .This means not working with big business who seem to water down any plans to tax energy dense junk food and for instance block cheap pricing of alcohol supermarket
    sales .It wont be cheap though to employ Gps out of hours and many are burnt out already .I agree that maybe we should be making the worried well more self reliant ,perhaps too , rewards for those who look after their health.

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  • The figures will be massaged, then statistically analysed to claim this is a success and what "consumers" want, Ivan will be in the honours list and all GP practice's forced to work longer within present resources!?? RIP gp?

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  • I am not a GP but I do feel for what is being demanded of you in ever diminishing budgets. I think they will have to rethink their plans -maybe they could propose a more flexible less 9-5 schedule without an increase in hours -just so many patients who work can't actually get to see you -presently i would struggle BUT i would rather have a service that can provide then ALL hours opening with no resources!!! These days workplaces penalize anyone who attends a GP appointment during their working hours -guess what I didn't follow up with my over 55yrs check up? Why? would have had to take time off work and be in trouble with my employer.....

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  • No primary care workers elsewhere in the world offer unlimited access to routine care 12 hours per day 7 days a week. All of this for basically the same pay in a country with almost double the number of patients per GP. This will not be sustainable. Young Doctors are already choosing NOT to become GPs due to the existing stress and better work conditions and pay elsewhere.

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  • Its like putting a service to compete with the OOH providers.
    Set the house straight with a robust OOH service and you dont need these locality GP services

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