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.
