Irresistible force heading for immovable object

We have a situation, as an irresistible force rapidly approaches an immovable object.

Freshly elected Cameron wants the NHS, including the GPs, to provide a 7 day service.  The BMA says no.  Everyone knows Cameron’s only real weapon is cash, in short supply just now, and the doctors will “win” this battle as they always do.

But look where the famous “win” of the 2004 GP contract has left us.  Successive governments trying to claw back money for 11 years, QOF a bureaucratic nightmare achieving nothing for public health, and a GP workforce heading for the exits.

In this war, we all end up losers.

So instead let us reason together, and let the evidence guide us to pragmatic solutions.  The answer lies with understanding patient demand.

We have shown that even with 24/7 availability to your own GP online, 88% of demand is in hours.  In one practice, average medical problems submitted, last four Sundays:  4.  Last four Mondays:  65 (and only one in 20 of these after 6pm).

There is no need to open 7 days a week, or up to 8pm even on weekdays.  There is a small number of emergency demands, which can be covered by a multi-practice OOH service.

The hub and spoke idea proposed by many PMCF and Vanguard sites could work if the flow is right, and even patient choice can help us deliver efficient service. Online access makes this possible as different options can be offered depending on the day and time.

Many patients asking for help OOH don’t need it now, but given the choice will wait until their own practice is open.  Continuity of care is preserved and rework eliminated.  The key is to make the choice easy and the service responsive, and that’s the service we are helping a number of GP groups to design.

Let’s not wait for the crash.

Harry Longman
Founder, Chief Executive
GP Access Ltd

PPS You really must read this on the collapse of a 7 day PMCF funded service in N Yorks.  Patients booked just 12% of available slots on the Sundays, and 50% on Saturdays.  And they didn’t like the hubs, they wanted to go to their own practice.  Pesky northern patients, obstructing what Cameron has prescribed for them and wasting all that taxpayers’ money!

Ah but, it’s the same story in Hertford.  Will Hereford and Hampshire follow?

PS Can anyone help me get the RCGP heads out of the sand?  They just wrote this supposed blueprint for general practice.  Get Uninspired!  It’s the usual mix of hand-wringing and begging bowl approaches.  Chapter 5 on innovation is nothing more than asking for money.  They mention Skype, like everyone does, though there’s tiny takeup and no evidence of it saving GP time.  But no mention of telephone consulting, with its mountains of evidence from thousands of their own members.  Nothing on the untapped potential of online interactions.

We just carry on regardless.  Three more launches this week, one typical comment “Have been very pleased that it has been going so well, all of the staff seem impressed, along with the GPs and some very good comments from the patients.”

Comment on this blog

2 responses to “Irresistible force heading for immovable object”

  1. Ivan Benett says:

    Of course the main reason for a 7 day service is because of safety in hospital. In order to do this effectively there needs to be a Primary Care support through seven days too. However, in addition there are large swathes of the population who cannot attend easily during normal working hours, and the telephone isn’t the complete solution. These groups include people who work, who have carers who work, who are in full time education. These people need to have suitable access rather than be penalised. After all, they pay for the service. In addition you will see that with extended hours we can impact on A&E activity and at a price we can afford! And it is hugely more convenient for those groups who can’t just bunk off work for their smear or stomach pain.
    There is no doubt that telephony is key to better access, but only as part of a whole system change.
    Finally, seven day NHS is here to stay so we might as well get on with it.

    • Harry Longman says:

      Safety in hospitals is an important issue and we need to be guided by the evidence. The evidence I’m showing in primary care is that given a free choice, the demand out of hours is very small, not zero, and yes we do need to meet this for clinical reasons.
      Reasons of convenience are different. I’ve written previously, convenience is not enough. Where we are failing patients now is denying access in hours (one in eight patients is told, “Sorry, nothing left, try another day”). It is the wrong priority to offer non-emergency appointments out of hours when so much failure is left untouched. We can’t see other professionals at weekends, for our convenience, so why should we see a GP? It’s fascinating to see how weekend appointments are being scaled back, for lack of demand.
      The GP workforce is utterly miserable at the moment, if we believe what RCGP/BMA pump out continually. 7 day working will only make things worse. Listen to the GPs.

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