I don’t know quite what NHS England is thinking. Are they thinking we need to have continuity of personal care, or are they thinking we need continuity of record? They are two different things.
If they want continuity of record, access to a GPs’ records, well there is a pretty straightforward IT solution for that.
On the other hand they are talking about the continuity of personal care, so the same doctor looks after someone who is ill day and night. That means GPs being personally on call 24/7.
If this is the case, then we’re going to go back to pre-1990, when we were always on call for our own patients. Now, having been single-handed in the mid-1990s when I was personally on call from April through to late August without any break whatever, even then that was intolerable. With the increased pressure in general practice now that would drive most people to an early grave.
It is not good enough to have someone from the same practice, or from the same group of practices. That person who happens to be on call will not necessarily know the patient, and in many circumstances just will not know the patient at all, so there is no advantage to that.
Not all out-of-hours care actually requires continuity but there are patients, perhaps at the end of their lives, who do. Many GPs have already set up systems so that these patients always have someone to turn to, for example by giving them their mobile phone number for out of hours or in case of a disaster.
But to actually formalise that and impose compulsion will put such pressure on general practice that I think people of my generation will go off sick or take early retirement while the younger generation will just leave the country in droves – that is a total tragedy.
NHS England has not actually identified a problem here, and until they identify a problem they can’t identify a solution. I think there is a remarkable absence of clarity of thought in political circles about what is going on.
This has all been prompted by difficulties in accident and emergency. Over the past number of years hospital staff numbers have increased while general practice staffing has stood still and had a significant increase in workload. Yet A&E is screaming – we should be screaming but we’re not.
Dr Peter Swinyard is a GP in Swindon and chairs the Family Doctor Association