We are going to see a royal punch up over the GP hours proposal. Yes, access to GPs is often difficult – if it’s not difficult for you, then ask some friends. And yes, GPs work very hard and often long hours, and they really are more fed up than for a long time. With this background Cameron’s call for more of the same is looking courageous, as the civil servants say.
What we need is evidence of the real problem, and I’ve got some from one typical practice. At the foot of the chart, time of the day, and at the side the number of GP appointments booked. We call this the Blackpool Tower, and you can imagine what it’s like being in reception at 8am with the queues and the phones going crazy. From then on you can look forward to the rest of the day, saying “Sorry, all gone, call back tomorrow.” and suffering a mixture of abuse and lies from patients desperate to see their GP, whatever it takes.
Imagine (you probably know) what it’s like being a patient, trying to get through at 8am, redialling again, again, again, hoping to win the appointment lottery just this once, please. Cameron gets this, and he’s right that it’s wrong. But look at the other end of the chart, 18.30, where he wants to extend the hours into the evening. Nothing is happening, few calls and no bookings. The problem is, extending hours just increases the time spent saying “Nothing left, go away”. Will the extra appointments be filled? Of course, they always are. Appropriately? I’m not sure.
What patients want is access to their GP. Our next chart shows what happens when they have free access. They tend to call a lot at opening time, as it’s human nature to wake up ill and call the doctor. But when they can book all through the day, they do, tapering off towards the end. Again, there’s little call late in the day, when Cameron wants to extend the hours. In the first chart all the bookings are for face to face, in the second for a telephone consultation. The doctors can solve about 60% of the problems over the phone, but if a face to face is needed it is always offered the same day. The GPs aren’t working any harder, in fact they have free slots in most sessions. Patient demands are flat or declining,
There is no call here for extended hours. Weekends? Sure, there would be some demand, but it’s covered by out of hours doctors. Not quite the same as your own GP, but adequate. Think about the GPs for a minute – they need to have a life, and if we want to attract and retain well motivated GPs, the working hours must be sustainable. GPs working all hours is not a one way bet to a safer primary care system.
A secret: both charts are the same practice, Clarendon in Salford as it happens, just a couple of miles from Manchester Central where the Tories meet this week, but a social world away. It’s a tough patch, but Dr Jeremy Tankel and the staff know how to run a general practice. The poster prize winning case study is here. How did they change in October 2012, and how do they combine 19 minute median response time with continuity increased to 85%? Take a ten minute taxi ride, Mr Cameron, and see what general practice can do, with no extra hours.
The pilot proposal for 12×7 hours is 60% more than current 52.5 contracted hours
- Is this 60% more capacity?
- Will you increase funding by 60%?
- Will you take the money from secondary care?
- Where will you find 60% more GPs?
- Will they want to work all weekend?
- What evidence that this will solve “the problem”?
Harry Longman MA CEng FIMechE (that’s an engineer)