Saturday, 31 October 2015

Headline grabbing initiative on 7 day NHS 'no benefit to patients' says BMA

Last year the Prime Minister, David Cameron, pledged to deliver a 7 day a week GP service by 2020. It was one of those pledges typical of Prime Ministers when they avoid the real problem - funding. In his announcement Mr Cameron said:

"Our plans for a truly 7-day NHS will transform services for millions of patients. It will offer hardworking taxpayers and families the security of the care they need at a time that is convenient to them. I want to pay tribute to the fantastic work of GPs and indeed all NHS staff across the country."

Frankly, it was an ill-thought through, headline grabbing statement.

The problem for patients in accessing a GP are not solved by opening all hours including Sundays. The problem is lack of funding and GPs under pressure to deliver in an overstretched system. There is little evidence that opening on Sundays would help alleviate the problems GPs face, or that it would improve patient care.

Now a report on pilot opening on Sundays shows that there is little enthusiasm from patients for such access.

Back in October 2013, the Prime minister announced a new £50 million Challenge Fund to help improve access to general practice and stimulate innovative ways of providing primary care services. 20 pilot sites were selected to participate in the Challenge Fund, covering 1,100 general practices and 7.5 million patients. Each scheme chose its own specific objectives, innovations and ways of organising services.

In the independent report on outcomes from the first wave of these pitot initiatives it was found that where Sunday opening was provided there was little uptake and concludes:

"Given reported low utilisation on Sundays in most locations, additional hours are most likely to be well utilised if provided during the week or on Saturdays (particularly Saturday mornings). Furthermore, where pilots do choose to make some appointment hours available at the weekend, evidence to date suggests that these might best be reserved for urgent care rather that pre- bookable slots."

In other words, there is no major benefit from GP Sunday opening. Furthermore, it needlessly stretches resources.

Responding to the findings, Dr Chaand Nagpaul, BMA GP committee chair, said:

“GPs have always been committed to improving patient access and already provide a seven day round the clock service. How we deliver further benefits to the public needs to addressed, but this independent evaluation of the challenge fund pilots raises serious concerns about the value and expense of the government’s inflexible approach to seven day services for general practice.

“There was extremely poor demand from patients for appointments on Sundays, and in many cases on Saturday afternoons, resulting in precious NHS resources being wasted on keeping near empty practices open and staffed. The cost of providing care during these hours was significantly higher than routine GP practice appointments during the week. While some areas showed a slight decrease in minor illness attendances at A&E, there was no reduction in hospital admissions, and any cost saving would need to be balanced by the considerable expense of running these pilots."

GP services are struggling to cope extreme pressures. An ageing population with complex health conditions has increased the burden on front-line services at a time when social care services have been cut. Cuts in social care has a huge impact on the NHS, where each year £669m is being spent because older people are finding themselves trapped in hospital for days or even weeks. It also increases pressure on front-line general practice. Since 2010 funding for social care has been cut by 25% leaving a massive deficit in meeting a growing need. Families are left unsupported.

General practice is currently facing a tough financial climate. Since 2008, General Practice income has declined by 11% whilst the cost of running a practice (including the amount spent on keeping GP practice buildings in good shape, energy bills for GP practices and the amount spent on GP staff, including practice nurses and receptionists) has risen. As Dr Nagpaul says:

“At a time of extreme pressures on GP services, with many practices struggling to cope with patient demand and falling resources, the government needs to learn the lessons from its own pilots. A number of those areas taking part decided to stop providing weekend sessions owing to lack of demand. Two thirds of the funding for this project was actually spent on worthwhile schemes of benefit to all patients across the week, such as improving digital infrastructure and measures that enhance collaborative working between GP practices."

The government needs to ensure that GP services have the resources to meet the 'incredible demands' being placed on them and not be distracted by headline grabbing initiatives which do not deliver benefits to patients.



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