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Independents' Day

Is it time for GPs to embrace seven-day working? No

I have experience of seven-day working, Dr Amy Small writes, and it won’t change a thing

Like many GPs, I am not happy about the suggestion put forward by the chief inspector of general practice, Professor Steve Field, last week that GPs introduce seven-day working.

As our workload has become unmanageable, our days have become longer. Many of us have moved to work ‘part-time’ (40-hour weeks) to keep our health and sanity. As a consequence, continuity in care has become much more difficult to achieve.  

If we are now to offer appointments seven days a week this will disrupt continuity of care furthermore. The more that we are expected to be in the practice the thinner we will have to spread ourselves. This will meant more time spent away from our families and exhausted GPs are a grave risk to patient safety. With the looming workforce crisis there simply won’t be enough GPs to provide cover for all the hours proposed.

I worked in a practice in London three years ago that was open 8am-8pm, seven days a week. As a locum working Sunday mornings, I effectively got paid to read the paper - very few patients wanted to come to the doctor on a Sunday morning. For those that did present, I often ended up bringing them back mid-week for other services such as phlebotomy, as no other primary care services were open on Sundays, except A&E of course. Even the local pharmacies weren’t open after 6pm (or sometimes, at all) on a Sunday. I can honestly say that I never once prevented an A&E admission.

No solution

Seven-day working just appears to be another half-baked idea that’s going to be rushed through to pander to the worried well voters.  I don’t see what I will provide differently on a Saturday compared to my local out-of-hours service. It is largely staffed by local doctors who provide a good medical care.  Maybe NHS England could learn a few lessons from how OOH is run in Scotland.

Why are these ideas being postulated? I can’t help but feel that we are trying to create sticking plasters as opposed to tackling the root problem. We need politicians to have a frank discussion with the public about what can be expected from the NHS and what can’t. I’m constantly surprised at the number of people who present with sore throats, who’ve never tried so much as a paracetamol before booking an appointment.

Employers need to acknowledge that their employees will from time, to time, need to take some time off to see a doctor for something that is important to them – their health. Their employees need to be supported in this. We need to make more use of community pharmacies signpost people to the services they offer.

If the Government wants us to be open for more hours then they need to invest in us and our infrastructure, stripping out the bureaucracy and ensuring our workforce is ready and capable before forcing this on us. This could be done by cutting out huge swathes of QOF (but not the money that goes with it), protecting our pensions, or investing in our premises, to help prevent mass retirement in April 2014.  

As it stands now, it’s going to be a costly experiment and I don’t think it’s the answer to the problems we are currently facing.

Dr Amy Small is a GP in Edinburgh and a member of the GPC.

Read more: Dr David Geddes argues the other side of the debate

Readers' comments (15)

  • Thank you Dr Small- so correct! We HAVE to open for extended hours already and all the patients I see are those that would normally see doctors at normal times but want to see me and can't get an appointment at other times as I am only parttime. They are always surprised the surgery is still open. It would be even worse on Sundays. Politicians are SO IGNORANT of the real situation in general practice and we are their scapegoat for all NHS problems whereas THEY are the real cause. If this comes in and I am expected to work weekends then I will retire aged 46!

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  • I absolutely agree with you. We are not A&E, so should not be treated like A&E.

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  • As an inner London GP I wholeheartedly agree. We have an OOH service and patients need to be educated to use it and not A&E. Our day to day work requires us to work in a team to look after our complex patients and to discuss patients with our health visitor, district nurse and hospital colleagues - even talk to each other! Don't try and dilute us any more!!

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  • Amy
    you are very correct working seven days a week will not
    resolve the Demand overload. If A/E and general practice to survive,we need to address the demand management.
    DOH should take on the issues of,
    Patient education.
    Patient empowerment.
    Patient accountibility for resources proper use
    Principle of Self care.
    Health service is for ill health and not for worried well.
    Stop using NHS as a Conviniance commodity, because its free at the point of access.

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  • Dr Small and Dr Ferriday...... I totally agree with everything you have said. I shall be resigning from my partnership if I have to work a child I recall that my own surgery was open between the hours of 8am and 9am then again between 4pm and 5pm. For the rest of the day the doors were locked. If you arrived at 1 minute past 10 you did not get in! Our doors are now open from 8.30am (phones from 8am) until 6.30pm and we have a constant stream of patients attending throughout the day, outside of booked surgeries all insisting that they are seen. Surely this is adequate access. Employers should be made to allow their employees time off to visit the Dr in the same way that women are allowed time off for antenatal care.

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  • As you have said, employers who do not release their employees for appointments or make them provide evidence for the same are part of the problem - perhaps rather than throwing money away on 7 day GP working this could be diverted to incentivise employers to be more responsible.

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  • Perhaps employers who claim they cannot give their employees the time they need to look after their health during the normal hours funded by the NHS should consider providing them with private medical cover

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  • Bob Hodges

    Well played Amy! Elegantly put.

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  • we had early visits starting at 730 for working people.. mostly DNA's or retired people who get up very early. The program was scraped as it was ineffective.

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  • I think old days are coming back . In the past GP used to live above the surgery premises . The NHS should provide a family accommodation for GP so that he/she could fulfil his/her obligation and maintain work/life balance to some extent. I think it is a crazy suggestion to a crazy proposal.

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  • I agree Amy....well said.
    Steve field lives in a dream world.....the government has put him up to this .....this is exactly why someone such as yourself should be representing grass roots GP's who are working full or half time. HE SHOULD NOT and certainly not be in a role as 'inspector of general practices' insulting to us as GP's that a past colleague is now to 'inspect' us...will there be pass and fails?...expect so.....sounds so pedagogic its untrue. We are NOT a 24 hour service. I admit Patients cannot predict when they will become ill but there is a place for them to attend if they believe their problem to be urgent and cannot wait until their GP surgery is called either the A and E and/or the local GP O of hrs centre. There would be no manpower problem if you put GP's into local A and E's, pay them properly and they will sort out this o of hrs mess.....!!.....
    When I started in practice in 1983 we were on call a whole w/e followed by a half w/e ie sat and sun mane 9am until 1pm alternate weeks. I would see 30 of my Patients on a sat morning and approx 15 to 20 on a sunday each w/e day without fail. Mostly self limiting illnesses which I and my Partners sorted over time with health seeking behaviour modification etc......when o of hours disappeared where did all these extra Patients go and were our Patients worse off?.....our week day work load did not really change that much and certainly they have been no worse off from our analysis of subsequent disease presentations etc. This 24 hr thing is just political whim and the use again of the NHS as a political football which has to stop. It is also catering toward a nanny state.... something which the governemnt seems to want to encourage so as to finally break primary care so that they can then blame GP's for not 'playing the game' so they will then feel justified in privatising it.. If we as UK GP's do not have someone amongst us rising up and prepared to stand againt this government it will unfortunately be the death knee of Primary care as we know it.

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  • As I already work for the out-of-hours service- at weekends & in the evenings. I would not mind working during these times. However I can pick & choose the hours I work. The pay that I receive is mine however, but it is'nt megabucks. At least this money that I earn is mine & not the practices. The government as I see it wants to divert money from QOF to pay us for working extra hours. It would simply get absorbed into the practice expenses with little coming our way- so I would be working for nothing. Will I be able to take an extra half- day off & come back in the evening to do any extra hours- I doubt whether this would be allowed judging from the way we have to strictly adhere to the terms of our current contract for providing extended hours.
    What about those practices that are staffed by P/T GPs. When I first came into General Practice in the 1980s, we had no appointments & I did not get home till 7pm. If I did not take my children to school in the mornings, I would never have seen them as they were in bed when I got home. Male GP.

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  • why should a gp work 24/7.are we not humans?will an MP,a teacher,Police man/woman or even a road sweeper work 24/7? There is madness in the mind of those who thnk that GP can give a service to the public 24/7.Sad and very sad for those who want the Gp to work 24/7

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  • Agree with Amy , all for political gain

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  • Well said, completely agree.

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