Seven-day GP services may not be the first thing people reflect on when discussing former Prime Minister David Cameron’s legacy. But, like his gamble on Britain remaining in the EU, things have not quite gone according to plan.
Evidence from the pilots has shown patients are not very enthusiastic about seeing their doctor on a Sunday. And although the scheme does reduce A&E attendances, the costs have been shown to outweigh the savings by as much as 15 times.
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But it remains a political imperative and last month NHS England released its plan to implement seven-day services across the whole country. It will give all CCGs £6 per patient to implement seven-day GP access from 2019.
Pulse’s calculations indicate the whole exercise is expected to cost at least £1.5bn by the end of 2020/21.
But even with these figures, Mr Cameron’s original commitments will not be fulfilled. He had promised access to GPs ‘from 8am to 8pm, seven days a week’ at the Conservative party conference in 2014, but it is not what will be delivered.
NHS England specifies an additional 1.5 hours’ access on weekdays but no 8am to 8pm opening at weekends – only some level of prebookable and same-day appointments ‘on both Saturdays and Sundays to meet local population needs’. And appointments can be provided from a local hub rather than every practice opening at weekends (although to be fair to Mr Cameron, this was the reality of his policy from the start).
GPs have pointed out that the £6 per patient funding is way below the funding given to some of the pilot schemes that did provide 12-hour access every day of the week. For example, the pilot in Lambeth, south London, was given £9 per patient plus CCG funding.
So Mr Cameron may have only just moved on, but his dream of GPs seeing patients ‘from 8am to 8pm, seven days a week’ is already being watered down. And if CCGs wish to continue it, they will have to stump up more cash.
CCGs will need to cut their cloth according to this reduction in funding
GPC deputy chair Dr Richard Vautrey says: ‘It appears that NHS England has learned from the lessons of many of the pilots, which showed that there was little demand from patients for routine weekend appointments. There is importantly now no requirement to be open from 8am to 8pm on Saturdays and Sundays, with flexibility based on local needs.’
Dr Vautrey adds that the £6 per patient is ‘considerably less than many have received previously’ when the Government put £50m into pilot schemes in 2014, and £125m in 2015.
He says: ‘With a shortage of GPs and reduced funding, CCGs will also have to consider using other health professionals to provide these appointments.
‘CCGs will now need to cut their cloth according to this reduction in funding.’
And this is happening already. Dr Ross Dyer-Smith, a GP in Lambeth and principle spokesperson for the Lambeth GP federations, says their seven-day hub – which offers same-day urgent appointments – is already cutting back on services because funding has been reduced from £5m to £2m.
Although, swimming against the tide, NHS Lambeth CCG is commissioning further appointments on Sunday, even though there has been shown to be little demand.
Dr Dyer-Smith says: ‘The original service was 8am-8pm Monday to Friday and 10am-6pm Saturday and Sunday. Now it has gone down to 12-8pm Monday to Friday and 8am-8pm Saturday and Sunday. So we have reduced weekday opening and increased weekend opening.’
He adds: ‘That is based on Government policy and what the CCG requested based on the seven-day NHS pledge. Although actually we found that Sundays weren’t particularly heavily utilised, it has been very much a Government drive to increase that capacity at the weekend.’
Asked if he thinks that is the best use of the money, Dr Dyer-Smith says: ‘If I am honest, based on my experience of working in the hubs on those days, probably not.’
Leeds GP Dr Patrick Geraghty, who helped set up his local seven-day access hub, says it is working well, but only with significant CCG investment.
We are gambling on a new system when we don’t know whether it is going to work
Dr Geraghty says: ‘We know £6 per patient is not going to cover extended access from Monday to Sunday. At the moment, we are very lucky that NHS Leeds West CCG funds us £13.10 per patient on top of the NHS England funding. I don’t know what we would be able to offer from Monday to Sunday for £6 per patient. It wouldn’t be much of a service, to be honest.’
But others are more optimistic about the viability of their access schemes. David Pannell, chief executive of the Suffolk GP Federation, who has led a pilot, says: ‘It looks like quite generous funding, which I think will allow people to offer a good service – provided the service is done by quite a large group of practices. This is quite a big increase on what we received via the second wave of the GP Access Fund.
‘It will enable us to cover a much larger population with a very good service.’
But there is also an opportunity cost. And it sticks in the craw of many GPs that the NHS is planning to splash yet more cash on extended access, while they struggle to provide a safe service in core hours. As the House of Commons Health Committee has warned, the Government will be forced to foot the bill by making cuts elsewhere in the NHS budget.
Doncaster LMC medical secretary and GPC member Dr Dean Eggitt calls it an ‘appalling’ waste of money: ‘We are gambling on the prospect of a new system when we don’t know whether or not it is going to work.’
Dr Eggitt says this represents yet another inducement for GPs to move away from traditional surgeries and embrace ‘at scale’ working, in line with NHS England’s Five Year Forward View.
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He says: ‘I think the Government is hoping smaller practices will die out and bigger practices will naturally want to take on the bigger contracts with seven-day access. That will take several years of course, but I think that is the direction we are going.
‘And this kind of initiative is just one of the incentives to move us on in that direction. This money is being given to CCGs so they can then incentivise practices to work at scale and provide these sorts of services.’
And there is one big question that has not been answered: what will happen to the extended access DES? In 2015/16, 73% of practices received at least £1,000 via the DES, but Dr Eggitt says he expects this to disappear soon.
He says: ‘My personal expectation is that we are going to be moving more towards 8-8 contracts and the extended hours DES is going to be void and die out anyway.’ And so the GP access policy wheel keeps turning.
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