GPs: open all hours?

One of the dangers of letting political parties have conferences is that you have to put up with the governing party announcing a load of new policies. One of the dangers of letting the Tory Party into government is that they announce new policies faster than they can give serious consideration to thinking those policies through.  And so it came to pass, at the start of October, that David Cameron announced that he wanted GP surgeries to open from 8am to 8pm, seven days a week. Nine areas, which have yet to be announced, will join an existing pilot scheme in Manchester to test the new scheme out, and then it can be rolled out nationwide.

Cameron explained that the 12 hours a day service is a modern system, helping patients to make an appointment which fits in with their work and family commitments. Health Secretary Jeremy Hunt went even further: “we need GPs to find new ways of working so they can offer appointments at times that suit hard-working people.”  (They get all the policies, these “hard-working people”, don’t they? Who’s making policies for the idle layabouts?)

What Cameron and Hunt didn’t explain was where the extra staff are going to come from to keep the surgeries open. The pilot schemes are funded: but if the pilots are to be rolled out, is the NHS going to be able to fund the necessary staff? A huge number of receptionists, nurses and GPs will need to be available to work non-family friendly hours in order to keep surgeries open at times convenient to the hard-working people who can’t take time off work for medical self-maintenance.  That could cut unemployment – but it’s not like the Tories to expand the public sector workforce, is it?

This problem has already been picked up by the British Medical Association (BMA). Chair of the BMA’s GP Committee, Dr Chaand Nagpaul, said: “GPs are always open to new ways of working that can benefit patients. Many GP practices already offer extended opening hours and provide out of hours care to meet the needs of their local populations and provide the best quality care for patients. Crucially, for this to work the government needs to address issues around GP numbers and support services. Without extra GPs the existing workforce will have to be stretched over seven days, meaning potentially reduced services during the week. It will also require additional resources and investment in support and diagnostic staff such as district nurses and access to community care so GPs can meaningfully provide a full service across the week, and it remains to be seen if the money set aside will be enough to deliver this.”

Patients are already experiencing thinner services during the week, as this tale from a patient (who wished to remain anonymous) at a Tower Hamlets GP surgery shows.

“I have a medical condition which requires a regular, repeat prescription – a mixture of six different drugs.  Once a year, I would have blood and urine tests and a blood pressure reading and my GP would look at the results and review my medication. There would usually be an adjustment in at least one of the drugs – the strength or the frequency.
“Over the last three years, my annual review has been with the nurse. The nurse looks at my test results and decides if my medication needs changing. But if she thinks it needs changing, she cannot alter my prescription – so I have to go and see the GP to get a new prescription.
“I asked why there was a change, and the nurse told me it was to improve the service, because the nurse could spend more time advising me how to manage my condition than the doctor could. But all that advice turned out to be was telling me very obvious things about diet, smoking and exercise. As I have had this condition for years (probably since before the nurse was born), she couldn’t tell me anything I didn’t know. So I don’t think the review is being done by the nurse because she can do it better – I think she’s cheaper than the GP.
“It’s also weird that a decision on whether medication should be changed can be taken by someone not qualified to implement the change.
“The other month, I missed a review with the nurse, so it went over a year since I had had a review. I put in my repeat prescription, but the next day they rang me and said I couldn’t have a repeat prescription as it was over a year and I had to see a GP to get a prescription. They gave me a GP appointment the next day. At our practice, they only have a couple of regular GPs, and then they employ locums to fill out the hours. I saw a locum – someone I hadn’t seen before and probably won’t see again. As it was an emergency appointment, I hadn’t had any tests. The GP took my blood pressure, which was quite high. I told her this was probably because the surgery messed me about so much. She didn’t say anything more and just gave me my prescription. There was little point in my seeing a GP, as she probably did less than even the nurse had done…”

So before you assume the Cameron-led extended opening hours must be a Good Thing, stop and read between the lines.