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.