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Failure to fully consider the costs of seven day access is irresponsible

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The National Audit Office has revealed that the Government has failed to consider fully the consequences and cost-effectiveness of plans to roll out seven-day GP services across England by 2020. 

The Government can hardly afford its current model

The auditors, who analysed the pledges, found that the minimum additional capacity required by the new commitment equates to £230 per appointment hour at weekends and evenings for every 1,000 registered patients. In GPs’ core contracted hours, from 8am to 6.30pm, the cost is just £154.

It’s irresponsible and foolhardy to pledge seven day access to general practice without a clear idea of the additional costs or benefits it will bring patients or taxpayers. The health secretary has questions to answer. What is he really asking for? How does he plan to fund it? How will he ensure there isn’t a reduction in mid-week services or fewer GPs from Monday to Friday?

GPs are conducting millions more consultations every year while also facing a recruitment crisis. A recent BMA survey of GPs found that 84% said that workloads are now so unmanageable it is affecting the delivery of safe patient care. More than 80% of the public believes that doctors cannot deliver seven-day services without proper support, yet the health secretary makes no mention of the extra nurses, diagnostic staff, receptionists, admin staff etc that will be needed to deliver the high standard of care patients deserve seven days a week.

You do not have to be an expert to realise that the Government can hardly afford its current model, let alone generate a different emergency system and reduce the NHS budget by £30bn by the end of the next parliament. The priority should be efficient GP services and local A&E units properly staffed around the clock, yet the Government is shutting the latter as fast as it can and deliberately financially destabilising the former. 

The result is an unprecedented crisis, a devastating consequence of the lack of commitment to funding for health and social care, resulting in patients enduring one of the worst winters on record.

Nobody disagrees with Theresa May and Jeremy Hunt that a continuous evolution of the NHS is needed to resolve its massive problems but so far there have been no tangible gains. From Tony Blair’s time as Prime Minister to Theresa May’s current stint, the usual response to problems has not been to try to solve them, but to apportion blame while projecting the impression of safeguarding the NHS.

The current NHS crisis is a direct result of years of inadequate funding and politicians of all colours failing to take a long-term view on what needs to happen. Now is the time to put politics to one side and reach a cross party consensus on how to tackle this crisis. An injection of realism is necessary to stop the destruction of the NHS. Forcing reform after reform, or chasing spurious projects, like seven-day routine services, can only undermine the objectives of this publicly funded body and the morale of its workforce.

Given the scale of the workforce shortfall, shrinking budgets in primary care, seven-day GP services as promised to the public look completely unrealistic, neither desirable nor wanted.

Dr Kailash Chand OBE is a retired GP and former deputy chair of BMA council. You can follow him on Twitter @kailashchandobe

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Readers' comments (15)

  • NHS and politics have formed a toxic mix.
    Seven day NHS is ill thought political initiative.
    We don't have manpower resources or need for 7 day routine services!

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  • Even a 7 day service won't satisfy the extra demand it will inevitably create. Lazy GPs should be working 8 days a week, 25 hours a day, 366 days a year. Funding? Do me a favour, we all know they earn £250k a year already, they can do the extra hours for free.

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  • Irresponsible ?
    No...a criminal waste of NHS resources yet again by our failing political system
    How much suffering will this and the legion of insane ideological non evidence based waste schemes cause by draining resources further out of front line care,Mr Runt?
    This SoS is the apotheosis of incompetence and amassing stupidity

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  • Ivan Benett

    The NHS is under increasing demand, as demonstrated by the pressures on General Practice and more visibly by the A&E crisis. The solution must be funded increase in capacity and workforce. It also means extending the service to seven days a week. Of course this will cost more, and government need to recognise and resource it. But to say, as some seem, that there is no need for more capacity is to be blind to what is happening.
    Also opponents seem to say contradictory things. Some say there isn't the demand, and others that demand will grow to fill the capacity. Actually, the demand has already grown without an accompanying growth in capacity.
    We can argue about the causes of increased demand, but it is at least in part, due to reduced social care funding. Certainly something needs to be done about that too.
    To those who say that the extended hours aren't filled, well people generally aren't aware that the service is available, and don't know how to access it where it is provided. At our acute Trust, in an area where seven GP has been available, the rise in attendance and admissions has not been for GP type problems, but for more acute medical problems.
    There needs to be an increase in capacity of the whole Health and Care system, and a funded 7 day health and care service seems the obvious and sensible solution.

    There are some things that General Practice specifically could do to manage demand, particularly urgent care demand. This will mean a realignment of incentives.

    The first is to stop asking patients who want an appointment whether the problem is 'urgent'. Patients are reluctant to classify their problems as 'urgent', as they appreciate that there are many more 'urgent' problem than theirs. But many such problems do need to be seen that same day e.g. a bad cough that's been dragging on, a painful joint or back, constipation, severe migraine or headache and many others. They should be asked whether the problem needs to be managed that day.

    Secondly, the allocation of 'same day' appointment needs to be flexible to account for peaks and troughs in same day demand. The worst thing that happened to demand management in Primary Care was the 'advanced access' scheme, imported from America in the 90's. It was too rigid and has resulted in the bizarre situation of people ringing for an appointment but told to ring back later, by which time the appointments are full.

    Thirdly, GP practices need to be more proactive for a certain group of high risk patients with complex and long term conditions. For instance, there are certain markers of deterioration for many of these conditions e.g. weight gain in people with heart failure, increased breathlessness for people with COPD, low (or high) blood sugars for people with diabetes, deterioration of people with mental health problems. These patients should be seen and managed at that point rather than waiting for them to get worse.
    At that point they can be managed to prevent deterioration. Waiting will only allow things to get worse and often makes an admission inevitable, even though it could have been prevented. These patients and carers should be offered same day appointments also. At the moment, often they try to make an appointment but are put off for days, sometimes weeks. No wonder they end up as urgent admissions.
    The GP contract however, does not incentivise this sort of proactive work. The Quality and Outcomes Framework incentivise planned identification and management of long term conditions, but in a lot of places that is being discontinued, for the wrong reasons in my view. Hopefully it will be retained in most part, but for the rest of that money I hope it will be channelled into proactive same day care of people with long term or complex conditions.

    This also requires a 7 day service to be in operation - which of course needs resourcing. Kailash is right to point this out, but not to reject the whole idea of increased capacity through a seven day whole system service.

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  • Kadiyali Srivatsa

    This is a problem that has been discussed for years and is unlikely to be resolved. The main problem is because Gps are not looking at this problem from another angle.

    Unfortunately, it was GPs who advertised, encouraged patients to consult early. I picked 50 patients notes that were very thick and went through them, I realised 80% of them had no serious medical illness but was psychiatric illness.

    Then I looked what was going on when they were less than 12 month, the result was not surprising. The mother was bringing this patient to consult GPs more than 13 times/year. These patients developed deep rooted belief that they must consult doctor even though the symptom was trivial. The doctor diagnosed the illness as hypochondriac or depression and refers them to psychiatrist.

    I have conducted various pilot project to learn how we can bring in changes and make patients more confident so that they share the responsibility.

    In 2006, I was annoyed, because the nurses working in walk in clinics and nurse-led practice were making clinical errors and so I developed a tool so that patients will not consult a nurse when they must not. I don't want to go through my story now but soon you will hear. Now using the tool I developed a simple APP that will not only bring in changes we all expect. You can offer 24/7, 365 days service, work less, earn more and also create a database of your symptoms. This is like insurence policy because you are in control. If NHS crumbles, you have the contact details and so can continue to offer your service.

    To tell you frankly, I am not concerned about NHS but am worried about doctors like you in primary care.

    Please watch my video (https://youtu.be/WmT7pNZmZ-Y) and register as a doctor (www.7imed.com/maya) create your own Dr Maya apps that ask your patients to download Dr Maya and choose you as their doctors. Now you are all set to create your own network.

    Please note Dr Maya will help screen calls and reduce wasted consultations. If your name is in the database, you can offer advice, send email prescriptions, video consolation, refer and also book appointment. If the problem patient has is emergency, Maya will call 999, if the problem is common, Maya will refer patient to 111 and so you will get one or two calls in the night and also reduce 60% of emergency appointments. So its time you relax, see only patients who need your help and make nurses see more patients who you think are safe. Please check it out, lets take the bull by its horn. If JH thinks he is smart, we will prove we are smarter!!!!

    Please check this out because a day will come when one infected person will walk into your clinic and pass on an infection that can kill you (similar to ebola) and so be prepared.

    Read my article "Superbug Superbug Pandemics and How to Prevent Them" in American Interest and learn about a major threat that will be difficult to manage.

    I created this system not to save NHS but to help me because I did not want to get medical advice from a nurse who cannot differentiate penicillin from other antibiotics.

    Best Wishes.
    srivatsa@doctors.org.uk
    Please contact me if you need help, I am in London in February and will come over, help you create your net work...lets have fun

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  • Kadiyali Srivatsa

    By the way, I have also published a book Maya Bring Tears Of Happiness that they can use and learn how to differentiate common from serious illness and manage them at home. eBook costs less than what they pay to park their car in hospital car park in 1 hour. If the avoid one visit to hospital / year they save money. http://bookstore.authorhouse.com/Products/SKU-001078913/MAYA.aspx

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  • Looks like we need a 7 day GP press. Theresa May just declared war on general practice and it isn't a headline on here.

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  • Not so long ago researchers identified a polymeric mechanophore which gets stronger when stretched (if you're interested its in the journal Nature Chemistry 5(2103) p757-761). Unfortunately, this is not the case with the human capital upon which the blundering-forward of the NHS depends.

    This fact will not hinder the attempts of the DoH and the government from trying to extract more work from us in much the same way that a heartless pimp forces his worker to serve more punters knowing full well that her dependency on some class A drug will give her little room to complain. The dependency that doctors have could be a range of things from the mortgage, kids school fees, alimony or an over-entitled spouse; we may love to moan but the majority of us will take whatever crap is thrown upon us because like the prostitute we are bound up in servitude that often comes from our life choices.And I'm sure Mrs Mays advisors are aware of this and have little qualms in reminding her of this fact.

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  • Correction- the year of the article in Nature Chemistry is 2013, not 2103!

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  • Anonymous Locum GP

    - everyone agrees in principle it would be great

    - everyone (sensible) agrees in order for it to be achieved it needs resourcing (staff and money) BEFORE being started

    - sadly the government does not seem to agree on the resourcing part.

    the big question is what are our leaders going to do about it? we look to them for guidance. Are they going to talk and pontificate or do they have any useful plans. At the moment it seems the only response is that we have no choice but to accept it. I think individual GPs are going to step up their exit plans. I hope to be in the private sector within the next year. The point is this what are our collective GP leaders going to do when the NHS GP number fall to 20,000 are they still going to talk about it?

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