Dear Mrs May

I wrote last week to Mr Hunt and sat by the phone all weekend, but it appears ministers are not offering a proper out of hours response so I have little choice but to go direct to Emergency PMQs.

Your headlines:  “a large number of surgeries are not providing proper out of hours care – and patients are suffering as a result because they are then forced to go to A&E.”

GPs have a contract since 2004, mostly GMS or PMS, which defines their core hours.  Simply saying you don’t like it really won’t do.  The Telegraph has “Under Mrs May’s plans, GPs will have to be open from 8am to 8pm every day of the week unless they can prove there is not demand in their catchment area.”

We’ve been measuring demand for over five years and I can assure you there is always demand, but we do need a higher level of understanding from our PM, well intentioned and intelligent as you are.  Demand out of hours is predictable and perhaps surprisingly low, but covered by out of hours services (as provided for in the 2004 contract).

But you are confusing demand with capacity.  We know precisely the profile of demand, by day, by hour, even by minute, we know what is in and out of hours.  We also know that spreading the same capacity over longer hours will cut that capacity and increase costs.  When Sir Amyas Morse states “They are seeking to improve access despite not having evaluated the cost- effectiveness of their proposals and without having consistently provided value for money from the existing services.” it is well worth listening.  His NAO report says extended hours GP costs are 50% higher than core hours.  I’ve seen evidence that the true ratio is closer to three times.

Ignoring the evidence you have deeply upset GPs and confirmed the view of many that they are being bashed.  I could call this counterproductive but the language you’ll hear over the next few days is going to put such bland terminology in the shade.

I do more data nerdy stuff than emotions, but I want to finish on a note of hope and if you’re prepared to listen, read one thing.  Dr Philip Lusty was exhausted and beaten, along with all his colleagues and staff, as I personally witnessed.  Now read what happened.

Yours sincerely,

Harry Longman

One response to “Dear Mrs May”

  1. Ray Montague says:

    Thanks Harry

    I think the cost point is well made.

    In a cash strapped NHS the only justifiable reason for paying at least twice as much to extend routine capacity into extended hours is because you have run out of rooms.
    Why are the government and the DH so blind to the existence of GPOOH services? I have been helping to run ours since the 2004 contract change and I firmly believe that the care provided that replaced the previous arrangement has improved dramatically over those 12 years. And I was responsible for it before we changed!

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