Hunt: good analysis, flawed solution

When Jeremy Hunt speaks to the nation about general practice, I listen carefully.  He admits to successive governments failing to invest in what he calls the jewel in the crown of the NHS.  Hear hear.

The recognition is welcome, if he converts rhetoric into reality on workforce and investment.  Of course we are with the minister on the need for innovation and “imaginative use of technology”.  But trying to tie the carrots to the stick of 7 day working risks upsetting the whole lot.

In the same week that we read of PMCF weekend opening schemes closing for lack of demand, it’s simply exasperating to hear Hunt making 7 day working a condition for his “new deal”.  The crisis in the NHS is not one of convenience for patients, but of failing patients because of strained workload and capacity.  One in 8 trying to get a GP appointment in hours is turned away.

Every policy must be measured on these yardsticks:

  • Will it improve patient safety and quality?  7 days fails, as continuity will be lost.
  • Will it improve efficiency?  7 days fails, as it spreads limited capacity into periods of lower demand.
  • Will it raise workforce morale?  7 days fails, as GPs don’t want to sacrifice more family time.

Hunt confuses the issues.  He wants more continuity, a named GP, and routine appointments available more hours.  Please see the myths and the maths.  He wants to avoid A&E attendances for lack of a GP, but that is covered by OOH services.  Just one in 200 calls to a GP is an emergency.

To help the minister we need to take the lead on “how”.  Dozens of practices have shown how in becoming demand led, they can meet all demand in hours and out of hours demand drops.  The new lower, emergency level can be met efficiently through a large network of practices.  We can even enhance patient choice by digitally routing demand in & out of hours.

Technology plays a part, but new thinking is the key and evidence must be the basis.  Hunt quotes W Edwards Deming, “In God we trust, all others must bring data.”  We’ll hold you to that if you don’t mind Jeremy.

Harry Longman

PS Must show you this new poster we presented at King’s Fund last week on how online access with askmyGP has saved 100 face to face appointments per week.

3 responses to “Hunt: good analysis, flawed solution”

  1. Samina says:

    Brilliant idea

  2. Clive Smith says:

    Harry, I like you saw this published transcript from Jeremy Hunt’s speech and have written about the content in a more balanced manner rather than just follow the path of just criticising. The intent was well meaning and you title is a reasonable summary.

    My take is at least he has said it. He will as you say be accountable for his words. But also I am a great believer in driving change and any leader has to take a position and lay out his/her vision. It will never please all the people all the time. But to make an omelette you have to crack a few eggs.

    In my opinion it is not a flawed solution as what it has done is encourage debate which stimulates the very basis of his speech to get us thinking and seek to put forward innovation. The NHS system is potentially a flawed concept unless the people within grasp the task to evolve, innovate and change traditional practices. Technology can do a lot of course but it is attitude of those within and how we educate and provide the service to the patient/customer.

    Many have just picked up on the 7 days a week and jump to the conclusion we cant cope with it, we don’t have enough GP’s coming through from university, we loose talent to other parts of the world etc etc. The point is this illustrates my point. Seven days a week means innovating around individuals working in practices, changing working practices encouraging more people into the system using technology for an online doctor etc. Society has changed we all expect instant gratification and solutions on the go, Amazon, Google, Apple have all fuelled the desire and ability to order a service or product in the morning and receive it in the evening. So why not in the NHS service? My mother was a medical secretary, and recent needs for her to have a hip revision exposed me to the bureaucracy and how her generation revered the profession and that any doctors/surgeons word was gospel. Sadly this still prevails in the system and means legacy practices and systems are resistant to changing practices easily.

    Would more young people be encouraged into medicine if all student taking up this vocation from nursing to surgeon had their university fees paid for by the state, with a contract to serve a minimum period with the NHS. Controversial but just may address the skill gap.

    I am an entrepreneur and working in the area of pharmacy provision of repeat NHS prescriptions, here we have sought to change the status quo by operating and treating the patient as a customer. We have looked at our model to champion the patient, treating them as a customer so we deliver every single prescription to their home, we operate a call centre to speak with all patient/customers 5 days before their meds are due and ensure they need what they require. This will help to reduce down the £300m a year in wasted drug issued which reside in kitchen cupboards etc. Not only are our users enjoying the service they value the independence and dignity it provides in not having to rely on friends and family to pick up prescriptions and collect from a traditional bricks and mortar pharmacy.

    The point is it is about how to improve efficiencies and give the customer want they want. If a change is needed we help by liasing with the GP Surgery, the debate will continue but with a far sighted strategy and a keen sense of timing we can win and make a better NHS.

    Thank you for your article and opportunity to add my penny worth.

  3. Harry Longman says:

    Our ref: DE00000942565. Received from a DoNotReply email at DH, on 30/6/15

    Dear Mr Longman,

    Thank you for your email of 20 June to [an MP] about GP services. I have been asked to reply.

    I appreciate your concerns. However, ministers believe that expanding seven-day services is vital in ensuring that patients receive consistent, high-quality care. That is why the Government is committed to offering access to GPs services seven days a week, 8am-8pm.

    Ministers believe that expanding GP access will help people manage long-term health conditions and avoid hospital admissions. The Department understands that ease of access to GP services varies significantly across the country and that many patients are concerned about the matter. In a recent poll by YouGov, 54 per cent of respondents stated that access to GPs at weekends should be a key priority for the NHS.

    The Government has invested £175million as part of the Prime Minister’s Challenge Fund to test new approaches to accessing GP services. These approaches include telephone and Skype consultations, and new systems for the management of patients records. The 57 schemes involved in the Fund cover over 2,500 practices and over 18 million patients. Ministers hope that these patients will have benefitted from improved access to local GP services by March 2016.

    To meet these aims, the Government has committed to make 10,000 primary care staff, including approximately 5,000 more doctors, available to work in general practice by 2020. The Department has also provided £10million funding for a joint initiative with NHS England, Health Education England, the Royal College of General Practitioners and the British Medical Association that aims to expand the GP workforce.

    Finally, as you will be aware, since 1 April, all patients have had the right to a named GP who has overall responsible for their care. Ministers believe that this enables GPs to provide a more personalised service.

    I hope this reply is helpful.

    Yours sincerely,

    Bill Wright
    Ministerial Correspondence and Public Enquiries
    Department of Health

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