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You want seven-day access? Then, something’s got to give



I don’t wish to bore you with my domestic arrangements, but I had to stop a mini-war this weekend.

My two older kids were arguing over the ownership of my old phone, now solely used to play Minecraft. I suggested that the one who kept it should hand over their tablet to the youngest in the family, who has no gadgets. The argument was quickly resolved.

If children this young can understand resource rationing, why can’t voters? I am writing this after an election where every party promised an NHS utopia, topped by the Tory pledge to provide 12/7 GP access by 2020.

The entire premise is misleading because it ignores the fact that we already have access to GPs around the clock – it is called out of hours. Surely we should be increasing funding and supporting a robust out-of-hours service, rather than diverting it to provide routine care? It was disingenuous too, as the party also promised voters their own personal GP, implying access to them seven days a week.

We know this is impossible. Seven-day routine care will become as faceless as out-of-hours care. We will either work in federations serving 50,000 patients, not recognising
a single face, or we will have to reduce sessions in core time to spread ourselves throughout the week. Continuity of care will suffer as elderly and vulnerable patients may not wish to come to me at 7pm. All the evidence suggests that smaller practices generate fewer referrals and less unscheduled care, but we are moving in the opposite direction.

With talks over the workforce crisis occurring in high places, it is baffling that our leaders do not think seven-day working will damage recruitment and retention further. It is likely to push even more GPs to retire, locum or emigrate. Trainees will be less attracted to a career they have traditionally viewed as family friendly.

Now let’s move on to the economic arguments. Large multimillion-pound insurance providers are responsible for healthcare provision in many countries, including the US. Yet even these countries do not offer a 12/7 service for routine care. Why is this? No one could afford the premiums. But in this country, the taxpayer is expected to fund patients who consult on convenience, as opposed to need.

Without doubt, there is a small number of patients who have difficulty accessing healthcare in our 8.30am to 6pm weekday hours (not 9am to 5pm, as some seem to believe). Businesses should show greater flexibility for healthcare appointments and we should make greater use of telephone consultations. The extended hours DES hasn’t helped as it doesn’t allow differentiation between the working and non-working population, so my Saturday morning surgeries are full of patients who could have attended during the week.

But if this is a service patients want, they can’t expect it to be picked up by the national purse. As my kids have learned, you can’t have a phone to play Minecraft without giving up your tablet. What would the British public give up in order to see me on a Sunday?

Dr Shaba Nabi is a GP trainer in Bristol