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A faulty production line

You want seven-day access? Then, something's got to give

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I don’t wish to bore you with my domestic arrangements, but I had to stop a mini-war this weekend.

My two older kids were arguing over the ownership of my old phone, now solely used to play Minecraft. I suggested that the one who kept it should hand over their tablet to the youngest in the family, who has no gadgets. The argument was quickly resolved.

If children this young can understand resource rationing, why can’t voters? I am writing this after an election where every party promised an NHS utopia, topped by the Tory pledge to provide 12/7 GP access by 2020.

The entire premise is misleading because it ignores the fact that we already have access to GPs around the clock – it is called out of hours. Surely we should be increasing funding and supporting a robust out-of-hours service, rather than diverting it to provide routine care? It was disingenuous too, as the party also promised voters their own personal GP, implying access to them seven days a week.

We know this is impossible. Seven-day routine care will become as faceless as out-of-hours care. We will either work in federations serving 50,000 patients, not recognising
a single face, or we will have to reduce sessions in core time to spread ourselves throughout the week. Continuity of care will suffer as elderly and vulnerable patients may not wish to come to me at 7pm. All the evidence suggests that smaller practices generate fewer referrals and less unscheduled care, but we are moving in the opposite direction.

With talks over the workforce crisis occurring in high places, it is baffling that our leaders do not think seven-day working will damage recruitment and retention further. It is likely to push even more GPs to retire, locum or emigrate. Trainees will be less attracted to a career they have traditionally viewed as family friendly.

Now let’s move on to the economic arguments. Large multimillion-pound insurance providers are responsible for healthcare provision in many countries, including the US. Yet even these countries do not offer a 12/7 service for routine care. Why is this? No one could afford the premiums. But in this country, the taxpayer is expected to fund patients who consult on convenience, as opposed to need.

Without doubt, there is a small number of patients who have difficulty accessing healthcare in our 8.30am to 6pm weekday hours (not 9am to 5pm, as some seem to believe). Businesses should show greater flexibility for healthcare appointments and we should make greater use of telephone consultations. The extended hours DES hasn’t helped as it doesn’t allow differentiation between the working and non-working population, so my Saturday morning surgeries are full of patients who could have attended during the week.

But if this is a service patients want, they can’t expect it to be picked up by the national purse. As my kids have learned, you can’t have a phone to play Minecraft without giving up your tablet. What would the British public give up in order to see me on a Sunday?

Dr Shaba Nabi is a GP trainer in Bristol

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Readers' comments (9)

  • I would happily pay a supplement to see a gp for non urgent matter in the late afternoon or Saturday morning. Why not bring in top up payments for untriaged, extended hours or online booked appointments.
    Why do we assume GBP would not pay for this? They would quickly adapt and understand.
    Employers, or the self employed like many GPs, would benefit. Convenient appointments may be worth £100s to a gp locum or principle, but we don't need to commission this for £64000000 patients centrally via tax when those who benefit could chose to pay.

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  • Typo and correction: 64m patients not £64m! Also the £100s is the cost of locum cover or cancelling a booking if gps themselves need to see a Dr.

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  • Vinci Ho

    As I said all along, should pay a fee if you really push for these 'routine' GP appointments on Saturday and Sunday. Even so , the workforce crisis has not been dealt with. Hence , one cannot put the cart in front of the horse......

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  • Extremely patronising wonder so many kids think they are in control.

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  • Just extra indemnity cover for this alone is going to drive GPs away. Already cover is becoming so expensive for everyday work that the GP game is not worth the candle.
    So so sad to hear about people like Peverley and Moulson - just the tip of the iceberg.
    I fear that Mr Hunt and his imposed Contracts and snide remarks like A+E know elderly patients better than their own GPs [ when GPs see 90% of face to face consultations], pensions, CQC etc has already put paid to GP land.
    How can anyone join knowing that whatever is promised today, Mr Hunt can take away tomorrow.
    We need a new Contract and I mean a Contract, not unilaterally changeable.

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  • Want v need! Why isn't anyone addressing this? Children that get what they want beome brats. Me thinks that's what's happening with our patients. Politicians want it that way.

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  • Wait and see how popular it will be before more pt bashing Shabi...the public are not all obssessd with health issues and definitely not the medico politics you indulge in

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  • Anon 0925
    You are so right.
    Everyone these days wants their 'rights' without any 'responsibilities'.

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  • Totally agree Shaba-Out of hours is in crisis and needs proper funding or this house of cards will collapse

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