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What will patients sacrifice to get 24/7 access?



The Conservative candidate for Witney has recently pledged that his party would meet a predicted £8 billion funding gap for the NHS over the next 5 years. He recently met a fellow GP in his constituency to discuss the state of general practice. It appears that this funding will inevitably be swallowed up by the health convenience agenda and the ideological principle that he and other members of the public should be able to have access to ‘routine’ GP and other health services seven days a week.

He said to my colleague: ‘But if your child has a cough or earache, what’s wrong with wanting them seen immediately? Anyone would want that.’

And perhaps he has a point. But as a doctor I can see the flaw in his argument – it’s a waste of resources to see what mostly turn out to be self-limiting illnesses early on in their course. Sooner is not always better; it can sometimes take time to work out if a condition needs intervention.

The question also raises other issues. As general practitioners are paid per head of each registered patient, in addition to top up performance-related pay, it means that if every single one of our patients came to see us within the first 24 hours of having symptoms of an earache or upper respiratory tract infection, we would be completely inundated.

We would also be paid exactly the same amount of global pay. In all likelihood our performance-related pay such as the QOF, enhanced services and CCG-funded schemes would suffer as we would be so busy seeing acute minor illnesses.

My colleague made an important point to his MP. The issue is not just that what he thinks is unreasonable from a medical point of view, or from a GP workload point of view, but more essentially from the an opportunity cost point of view. Conceivably general practice could provide the public with more and more access, but without increased funding and staff to provide that access, then something else will have to give.

The implication, or rather the imperative, is that instead of promising increased access to general practice – which seems to be the default setting of many politicians – they should be asking voters: ‘What would you be prepared to give up for increased access to general practice?’

I have a few suggestions: offering free prescriptions for children; maintaining current taxation rates (to pay for more doctors and nurses); protecting the freedom to not turn up to a booked appointment without facing a financial penalty.

Something will surely have to give if the convenience agenda continues to be pursued. Let’s hope it’s not general practice itself.

Dr Samir Dawlatly is a former secretary of the RCGP’s adolescent health group and a GP in Birmingham