GPs condemn David Cameron's open-all-hours surgery plans

http://www.theguardian.com/society/2013/oct/18/gps-condemn-cameron-surgeries-plan

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Senior doctors have condemned the prime minister's pledge that GP surgeries will open from 8am to 8pm seven days a week as unrealistic and unachievable, as a Guardian analysis of existing opening times showed that just 1% of practices see patients on both weekend days and three-quarters are shut all weekend.

Only 100 (1%) of the 9,871 surgeries in England listed on the NHS Choices website are currently open for part of Saturday and part of Sunday, while overall just one in seven – 1,439 (14.6%) – open at all on a Saturday.

Those that are open offer access to a GP for on average only three hours and 25 minutes, far less than during an 8am to 6.30pm standard weekday. Three out of four (7,561 – 75.6%) surgeries are shut all weekend.

Even at surgeries that do see patients at the weekend, opening hours can be brief. Although four practices in Sheffield, Coventry, Wirral and King's Lynn open for 14 hours on a Saturday, the Village Hall surgery in Nottingham is open for just 30 minutes that day. More than 30 others open for an hour or less.

The findings underline the scale of the task David Cameron faces in honouring his promise, which earned widespread media coverage when he announced it at the Tory conference. Millions who find it hard to see a GP at a suitable time would benefit from the dramatic extension of opening hours, he pledged: "We want to support GPs to modernise their services so they can see patients from 8am to 8pm, seven days a week."

But doctors' leaders claim there are far too few GPs to staff such an expansion of opening times and the NHS is too cash-strapped to afford it. They have also questioned whether enough patients will want to see a GP outside normal weekday surgery hours, especially at weekends, to justify the move.

Family doctors' organisations warn that a large majority of patients who visit surgeries during usual weekday opening hours could face longer waiting times and not be able to see their regular GP if ministers press ahead with the plan.

"I think the prime minister over-promised an undeliverable service. The announcement isn't realistic within the resources that we have in the health service," said Dr Peter Swinyard, national chair of the Family Doctor Association.

The numbers revealed by the Guardian's analysis "ring true", he said. "They underline the undeliverability of the promise. It's not realistic to talk about GP services opening from 8 until 8, seven days a week – that's the bottom line."

Accusing Cameron of using spin, Swinyard said the new policy was an "unlimited rice pudding announcement: 'you can have anything you want, chaps'." Even the £50m the prime minister announced to pay for nine pilots of the scheme was taken from elsewhere in the health budget and was not new money, he said.

Dr Clare Gerada, chair of the Royal College of GPs (RCGP), said the prime minister was right to focus on expanding access for patients. "But the shortage of GPs means you can't provide that sort of access and expect it to be your GP you see on a Friday morning, for example, as he may be having a rest day after working all of the day before. If you move towards these 16-hour days, it will be less likely that your GP will be available at a time you can make," she said.

The drive to extend opening times overlooked the fact that, outside usual surgery times, many GPs were also looking after patients at urgent care centres and walk-in clinics and through 111, NHS Direct and out-of-hours providers, she added.

"My profession wants to find a solution to improving healthcare for patients. But you do that not by beating us around the head constantly but by supporting and investing in us," Gerada said. The royal college says the NHS needs 10,000 more GPs to cope with rising demand caused by an ageing population and the increase in long-term medical conditions.

Dr Chaand Nagpaul, chair of the GP committee at the British Medical Association, warned that weekday GP services would suffer if surgeries were routinely expected to open 8am to 8pm daily. "There could be a poorer service across the week if GPs are spread more thinly. It would just not be logistically possible to offer the same volume of care midweek if GPs and practice staff are spread more thinly over seven days," he said.

Mike Farrar, who recently stepped down as chief executive of the NHS Confederation, suggested that Cameron had erred in prioritising the needs of those who have trouble seeing their GP because they work long hours and may also commute.

"In an ideal world, all things are possible. But just at this present time, it's essential that the government is honest about the money available to the NHS and target the resources available to those with greatest need. That must mean that meeting the needs of frail, elderly people and young families should take preference over widening access for those with lesser needs during the weekends," he said.

Other senior GPs, such as Professor Steve Field, the new chief inspector of primary care, and Dr Michael Dixon, president of NHS Clinical Commissioners, have strongly backed longer opening.

Downing Street declined to comment on the doctors' concerns. But the Department of Health maintained that the extension was "entirely possible" and that plans to roll it out would continue, with some patients seeing longer hours from next April. "Millions of people find it hard to get an appointment to see their GP at a time that fits in with their work and family life and so it right that we look to change that. GPs do a fantastic job and we want to work with them to ensure services meet the needs of modern day life", a spokeswoman said.

The Guardian analysis is based on the opening hours of more than 9,000 GP surgeries from the NHS Choices website. In checking some of the surgeries advertised as having weekend opening hours, it emerged that some were in fact closed on Saturdays and Sundays. It is possible, therefore, that these numbers may overestimate the weekend availability of GPs.

Field, a former chair of the RCGP, plans to make access to GPs one of the key ways in which he assesses the quality and effectiveness of surgeries when he and his team inspect and later rate practices.

Ministers and NHS England do not expect every surgery to open from 8-8 throughout the week, especially as many have only one or two GPs. Groupings of local practices, perhaps operating a rota system, are likely to emerge, so that GPs can share providing the extra hours.

The health department said it was trying to tackle the shortage of GPs by encouraging more medical students to go into general practice rather than hospitals.

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