Soldiers to work 8-8, seven days a week

“Soldiers to work 8-8, seven days a week in government directive”

“Armed forces guarantee response to attack within 48 hours”

“All wars must start within 18 weeks of a referral from parliament”

Faintly ridiculous?  It’s ironic that the arm of the state occasionally tasked with shooting at things is less subject to targets than the NHS.  The defence debate centres on whether the parties will commit to 2% of GDP.  They fret little on how it is spent beyond vague notions of a more uncertain world, and agreement on a nuclear deterrent.  The generals, admirals and air marshals are left to get on with what they know best.

If only politicians would do the same for health.  Tom Cowling et al write a useful analysis of the evidence and rhetoric on access in this week’s BMJ.  Two basic errors are:

  • Tory promise on 8-8, seven day access to a GP, based on the false premise that’s what patients want.  Our evidence on demand shows in contrast that when in-hours access is easy and rapid, OOH demand is low to very low.  Spreading GP work into less used periods costs more, wastes their time and hits morale, therefore cutting access and continuity.
  • Labour promise on 48 hours to see a GP failed last time and will fail again.  61% of patients want same day, but by punishing non-compliance with the target, GPs will make 48 hours in effect the only option.  These appointments will be snapped up first thing every morning, patients will then be told to call back tomorrow, cutting access and continuity.

They all say more resources need to go into primary care. good, but I’m not hearing secondary care offer to give some back.  The answer has less to do with money, and more to do with method for how to change the system.  This is where Cowling hits the nail:  make appointment data available, evaluate new types, and consider demand.

Long term, how can we address the drivers of demand, inequality and public health matters?  Short term, we need operational measures for access and continuity which allow proper evaluation of what works.

We’ve put together a slideshow of what happens to waiting times to see a GP with a change of method.  It’s repeatable, sustainable and costs no more, usually less.  You’ll see why we call it the Dover Chart Collection.

There is no sign of a target or a government directive driving the change, just GPs deciding to do it.

Harry Longman
Founder, Chief Executive
GP Access Ltd

PS To illustrate how patients behave given complete freedom, a London practice offers online access 24/7 through askmyGP.  On Saturday 28/3 there were 2 online demands, on Sunday 29th just one, on Monday 30th 53, of which only 2 were after hours.  Ruminate on that Ed and Dave.

PPS  Some journalists seem equally bent on ignoring the evidence.  Last week’s paywalled Sunday Times piece starts with a wrong headline GPs deny advanced bookings, above the picture of a queue, the very thing we see disappear from day one with our practices.  The Daily Mail simply copied the worst of it.  Anyone know a journalist who would be critical but open-minded?

Comment on this blog

4 responses to “Soldiers to work 8-8, seven days a week”

  1. Norman Boyes says:

    You know what you are talking about when it comes to the NHS and GP Access and it would undoubtably be better if politicians disabused themselves of the notion that they ever help with sound bite strategic dee-direction. However your military analogy is simplistic and wrong. There is every bit as much political interference in defence as there is In the NHS. This is particularly true in Defence Procurement who constantly get hammered for being over budget, when political interference in the project is usually largely responsible. Imposed political targets are as much a part of Defence Management as they are in the NHS.
    The truth is no politician would be electable if they were truly honest about the NHS and/or openly agreed that their hands were now off the tiller.
    We are stuffed.

  2. Harry Longman says:

    Norman, I bow to your superior knowledge of the military. It’s an analogy, perhaps not justified according to your comments.
    Let’s encourage politicians on both defence and NHS not to abrogate responsibility for outcomes, but to allow those in the services to work out the best ways to deliver them. Targets are part of the problem, not the solution.

  3. Chris Frith says:

    Some targets are good: Diplomacy before war
    Information kills diseases
    Dont let politicians abuse data

  4. Pip Hayes says:

    I have no doubt whatsoever that Harry’s stats are representative.
    Why do Jo Public need to bring their longstanding moles/coughs/aches etc on Mondays?
    However- the down sign of all this telephone triage, which I do all week, is that I can’t settle down to think about the dozens of results , letters, script reauthorisations which trickle in all day long.
    Hence – I stop being instantly available at 6pm and then get down to dealing with all of the above- and am leaving later and later.

    The patients with trivial problems get seen quicker than those with chronic problems and multimorbidities.

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