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Independents' Day

PM’s access drive is opportunity for GPs

The Government’s attempts to promote seven-day working might not be universally welcomed by the profession, but GPs have the chance to shape the debate, says Pulse editor Nigel Praities

We are but a year from a general election, and the policy gears are starting to shift.

While Labour promises to combine health and social care budgets, and ponders the return of the 48-hour GP appointment target, the Conservatives have their sights on a more radical platform.

GPs are front and centre of their plans, with the introduction of ‘named GPs’ for elderly patients and greater use of online services. But the centrepiece of their pitch for the nation’s votes is likely to be a significant expansion of GP opening hours – as a leading Conservative GP suggests this month.

The Prime Minister has personally endorsed the move towards 12-hours-a-day, seven-days-a-week GP access. He knows it is a popular policy, and after the controversy of his Government’s NHS reforms, he must be pleased with the national media’s response.

GPs will not be surprised if access features prominently in the Conservative Party manifesto come next May – but that does not mean they support the plans. The prospect of an 84-hour working week for practices is not something most GPs relish. As experts warn, the drive to expand access is likely to have an adverse effect on the other areas that David Cameron is prioritising, such as improving continuity of care for older people.

The £50m GP access pilot scheme only runs for a year, with practices receiving as little as £3 per patient. This is not going to transform primary care. Practices in pilot areas may be able to staff weekend and evening surgeries now, but there is little sign of the funding or the manpower needed to roll out the scheme more widely after the pilots.

But the profession finds itself in a bind. Practices face rising workload, plummeting income and little respite over the next year as costs rise. As GPC negotiator Dr Peter Holden predicts this month, general practice may have little more than 12 months before waiting times for appointments balloon and practices shed staff.

Figures from the RCGP tell GPs to expect an extra 69 million consultations a year on a shrinking proportion of the NHS budget by the middle of the next Parliament. These are serious times for general practice, which no party can afford to ignore.

In this climate, any new investment in primary care has to be welcomed – which might explain why so many practices applied to the PM’s access fund. The spotlight on GP services may be uncomfortable, but it also provides a chance to secure more investment.

The GPC has started to make this argument, but it must seize the opportunity to push for better funding. The debate over improving GP access must shift to a discussion over how GPs will struggle to keep basic services going without more funding.

A genuinely long-term strategy to improve access will need a much broader, bolder approach – reducing micromanagement, paying GPs consistently and fairly, addressing recruitment issues and influencing opinion-formers and the media to temper the relentless negativity towards GPs. Then GPs might have the time and inclination to fulfil the PM’s wish list.

The profession’s leaders can’t always determine the direction of the wind, but they can adjust the sails.

Readers' comments (4)

  • Turkeys and Christmas comes to mind

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  • GP's can no longer afford to cooperate with the DoH/Conservatives strategy for health. Stretching already saturated GP's for minuscule returns is good for government headlines and soundbites but not for patient care. More GP's retiring, less GP's training, longer waiting times, poorer service all round.

    The GPC should begin threatening to refuse the 2015-16 NHS GP contract, on the eve of the general election in May. This will get the Conservatives attention.

    Unless the DoH delivers a real plan to: 1. increased retention of GP's, 2. Increased training of GP's, and 3. increased funding of GP as per RCGP "Put Patient First Campaign", then the NHS GP Contract 2015-16 should be a "No Go". Mass Resignation of GP's from the NHS from April 2015.

    The BMA and RCGP, who are quite happy to encourage and develop advice to develop Federations to demise of small practices, should INSTEAD be coordinating the practicalities of nationwide resignation of GP's from the NHS, to the private sector one month prior to the general election.

    Withdrawal of GPs from the NHS would end the NHS, suddenly destroying the election hopes of the Conservatives. This is a threat they would need to take seriously and so drive them to a better fairer deal at the negotiating table.

    Either GP's take a stand collectively resigning in unison, or GP's will leave the profession piecemeal to the prolonged but steady deterioration of the NHS.

    Come on BMA! Adjust those sails and put it to ballot! GP Mass Resignation April 2015

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  • Not going to happen - we're too fragmented a group. Part time dr's interests are different from full timers, salaried different from partners. Business orientated vs traditional - mix and match the above!

    We're too easy to divide and conquer. There should be red lines but they were crossed and we did nothing. reality is until a few practices start going under -nhs england will twiddle their thumbs and until there is a crisis nothing changes

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  • Took Early Retirement

    I think your may be right Spec Reg. However, how many resignations would it take to destabilize things? Maybe a large number in one area and none in another would work well. I've made no secret of the fact that I'm off in a month or so now. I have a horrible feeling that things will rather just fester on with lots of grumbling and whingeing but no action.

    However, we have one hope... Una Coales!

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