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GPs go forth

Is it time for GPs to embrace seven-day working? Yes

Offering 40% longer opening hours needn’t increase GP workload at the same rate, argues Dr David Geddes

Across England, the story appears the same: general practice and wider primary care services are facing increasingly unsustainable pressures and NHS staff in primary care want and need to transform the way primary care services provides care to reflect this.

The challenge is how to enable primary care to play an even stronger role at the heart of a more integrated out-of-hospital service, delivering better health outcomes, more personalised care and excellent patient experience, in a sustainable way and as efficiently as possible.

The elephant in the room is that we need to deliver all this seven days a week. Arguably, the current model of primary care is no longer fit for a modern NHS. We know increasing numbers of patients are presenting in general practice with multiple long-term conditions, working days are longer and retirement is getting later. Many of the population (myself included) never get the time to attend their GP surgery. At one event, the chief executive of a local hospital told how a consultant had to cancel his entire clinic so that he could see his own GP.  

If general practice is serious about offering health promotion and early intervention, then we need to be available to do this for people at a time that suits them.

More practice networks

So how can this be done when we are already facing a workforce crisis, when our own working day is too long and GP morale feels to be at an all-time low? How can capacity, that already feels so stretched, now be extended over seven days?

A recurring theme amongst GPs I’ve spoken to was that patients don’t need ‘more of the same’. Many described how they already have upwards of 40-50 consultations a day, seeing ever more complex problems, but with no slack in the system to give a corresponding increase in appointment length.

I work one day a week in a small practice of 5,200 patients, alongside three other part-time partners. We can’t offer a service 8am-8pm, seven days a week, on our own, but if linked with other practices who use the same IT system to create a practice network, we could.

In the past, we have worked as a small GP cooperative, where a relationship existed between practices and we could ensure an effective ‘handover’ of care for our most vulnerable, sick and dying patients. We told patients who they would see if they deteriorated, and we could share information with the attached community team.

That was more than 10 years ago. Now, with the highly systematic use of IT in primary care we should be in a better position to provide coordination of care across the seven-day week.

The challenges facing rural communities are far different to those facing inner city general practices, and resource issues will differ. However, I believe that this challenge offers us an opportunity to stop and reflect on our current way of practice. We should not see this as an 40% in our workload, but a chance to re-distribute our working week, and to ask how we can do things differently and more effectively as a consequence.  

More teamwork

We should create opportunities to meet with community health and social care colleagues to develop the team approach. Continuity of care should be measured in terms of how care is delivered by a well-informed multi-disciplinary team.

There will be advantages for the profession. As presentations in surgery become ever more complex, is it appropriate still to offer a 10-minute appointment with the option of an occasional ‘double’? Do we get professional satisfaction trying to manage a patient with three or four long-term co-morbidities within such restraints? Creating space for consultations across a seven-day period could be an opportunity to offer patients a range of appointment times, using skill mix and spreading the workload differently.

For many GP colleagues, juggling a career with a young family, working at weekends may provide much needed flexibility. And am I alone in finding it increasingly hard to know my colleagues across the GP community? In the days of the GP cooperatives, there seemed to be far more coming together, opportunities for discussion about patient care, about general practice and about life.

Working across seven days will give many practices opportunities to work together in a different way, reduce professional isolation and increase opportunities to collaborate, so that general practice truly will be able to play an even stronger role at the heart of a more integrated out-of-hospital service.

Dr David Geddes is the head of primary care commissioning at NHS England, and a GP in York.

2016 seven day access click back banner 580x60px 2

2016 seven day access click back banner 580x60px 2

Readers' comments (71)

  • I too have had to cancel surgeries or take holiday in order to attend hospital appointments. The natural extrapolation of your argument is that all providers of services to the general public should provide services at the week-end so that no one is inconvenienced or compromised in any way. Also the providers should be told this service will be provided at no extra cost.Why should this only apply to GP's?

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  • "I work one day a week" - in other words you have no idea of the concept continuation of care and no idea of the stress of full-time 'coalface' GP work. You article is idealistic and totally naive and is a worrying reflection of someone who potentially represents us all at NHS England.

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  • We don't "need" to deliver routine services 7 days a week - this is political vote-winning stuff without appreciation of the costs, both financial and in terms of GP recruitment and retention. I can't believe a GP (albeit a one-day-a-week one) is supporting this. We "need" 24 hour emergency care, routine care in normal hours (already longer than most people's working days) flexibility of employers around allowing staff to keep health care appointments (or suggest they invest in private health care for their staff if not willing to do this) and for patients to stop making unnecessary demands on the NHS.

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  • Idiot. Just put him on ignore!

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  • I would like clarification of the increased medical defence fees that will be levied . presumably somewhere around the £10,000 mark . If we have to pay this then we will need to earn more cash - will we get a 10% pay rise to cover it ? Very unlikely therefore it would mean a pay cut and if you expect more work for less it will not happen.

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  • This is disturbingly naive. Seven day working could only ever work properly in a privatized NHS because it introduces consumer expectations into healthcare. We would simply never keep up with demand. As it stands, GPs and hospital doctors are on their knees and the service is rationed by availability. Demand for GPs at the weekend would have to be tempered by fee payment because we barely have enough doctors to staff the present system. The bulk of general practice users remain those who have retired, young mums or those with long term illness ie people who can best attend during the week. If you moved to shifts GPs would literally be skeleton staff. The last thing doctors with young families need is shift-work, you only have to see the damage done to some of our less fortunate shift working patients and the staffing crisis in A+E to draw this conclusion.

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  • Question for Doc Ged.

    Presumably our 7 day a week access will be matched by 7 day a week access to hospital services too ie. pathology XRay, MRI scans, OPD etc etc etc

    If not why not?

    If so how much more will it cost?

    Also how many hours a day should a GP work and how many patients should they see?

    I think we should be told

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  • ONE DAY A WEEK - absolutely clueless about the real life of a GP. He should become an MP !

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  • To have a GP who works one day a week have ANY SAY WHATSOEVER in the future of General Practice makes about as much sense as the Pope advising on the role of the combined pill in contraception

    Dr Geddes should stick to what he does best. Talk drivel and become a politician.

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  • I am dumbfounded by this man's article! AND TOTALLY AGREE with my colleagues comments already stated- get him off!

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