The announcement that Teresa May has today demanded that GPs in England remain open from 8am until 8pm follows on from David Cameron's aspiration to achieve seven days per week GP access by 2020. It will achieve many outcomes, some good, some not so good.
In the first instance, prospective medical students and junior doctors toying with a career in primary care will now have second thoughts. Under the existing system, a career in primary care has traditionally attracted those who wish to put family life first and enjoy a role at the centre of their local community. The idea of working Monday to Friday from 8.00 until 6.00 has traditionally been deemed conducive to a stable family life. It seems as though those days are now numbered and many would argue that this is long overdue.
Oh that it was that simple. Primary care is currently facing two huge problems. On the one had, it is being swamped with patients as never before and on the other hand, there is a national recruitment crisis. Planning to stretch the existing GPs to seven day working will inevitably make some think seriously about early retirement - and many already have.
This presents two huge challenges for primary care. In the first instance, they need to start addressing why it is that so many medical students continue to look upon a career in primary care as a last resort. Speaking from my own experience, too many doctors in hospital medicine continue to express ill informed comments about GPs. The medical students very quickly start to believe these judgments and become reluctant to even consider a career in primary care for fear of the perceived stigma. But as medical students, the medical schools themselves should be doing more to present a more balanced view of the available career options. During my time, I could have been forgiven for thinking that hospital medicine was the only option - that is a huge problem.
The second massive challenge for the next government is how to address the insurmountable numbers currently presenting to their GPs. It is well documented that up to 30% of those presenting do so with either no identifiable ailment or a condition for which there is no justifiable treatment. Just addressing this alone would have a huge impact on the working practice of our GPs. Another inescapable problem is that we are currently failing to make best use of the IT which is now at the fingertips of just about everyone. Anyone with a smartphone will probably have a camera on their phone. This means that many more consultations can be done utilising existing technology currently at the fingertips of most people. This will reduce patient travelling times while still giving the doctor the opportunity to assess the severity of the clinical picture in front of him or her. Although I would be the first to bemoan the impersonal nature of such an approach, it remains a viable, pragmatic solution. Given the recent news headlines relating to the detrimental effect of excess diesel emissions on our health, any solution which will reduce this can only be a good thing.
There is also the question of women doctors. Primary care is currently attracting women doctors on an unprecedented scale. There is nothing wrong with this except that many women doctors understandably wish to start a family and work reduced hours. Although this is a welcome development from the standpoint of obstetrics and gynaecology because many women understandably prefer to be seen by a female doctor, the part-time working hours can then exert even more strain on the finite numbers of GPs out there able to come in and fill that gap. This is another reason why seven day access needs to be thought through very carefully. If they get it wrong, they will just drive even more medical students and junior doctors towards hospital medicine. This will make the current crisis in GP recruitment even worse. But where do patients go when they can't get a GP appointment? Accident and emergency! And A&E departments up and down the country are at breaking point now!
But why is primary care so important? Put simply, if we don't get primary care right, hospital medicine won't stand a chance and we can kiss our NHS goodbye in it's current format ie. free at the point of access for every man, woman and child. It is an established fact that those countries which invest the most in primary care enjoy the best health outcomes. The only way we can begin to address the huge numbers in our hospital beds is to have more GPs to better manage them in their homes and in their communities. This is an inescapable fact. The current state of affairs is now futile. We have to do something different and while I welcome seven day opening in principle, I would warn strongly against the short and long term consequences for primary care in the UK. The current system of GP out of hours services works really well but I suspect that many people (through no fault of their own) are not always aware of how to access it.
If seven day access to full GP services is important, the same must also apply to hospital medicine. At present, hospital medicine continues to run a skeleton service at weekends. I suspect the real issue underpinning this debate is that doctors across primary and secondary care must accept that they will now have to work rota systems seven days per week. If these proposals are to work, they must be applied equally to primary and secondary care because the current divisions between the two are bad enough.
In a recent article in the Spectator, Rod Liddle wrote an interesting piece on this subject. Essentially, he was writing about our consumerist approach. But it is not just in healthcare that we have adopted this approach. "Black Friday" is necessarily a new concept driven by the ever greedy marketing men whose very existence depends on us all buying in to their carefully crafted strategies. This week, it was announced that the people of Britain continue to throw away tonnes of uneaten food but at the same time we read constantly about the growth of food banks for those facing destitution. When I looked out of my window on the day of the post-Christmas refuse collections, it was mind-boggling to see the endless rubbish waiting to be "taken away". Out of sight, out of mind...
Of course, the lay man or woman might be reading all of this and reflecting on the healthy salaries being enjoyed by their doctors. It is true that doctors get paid well but it is also true that they carry huge amounts of responsibility. It is also true that they study for years to get to that position and, in truth, in this post-Harold Shipman world, they never actually stop studying. That is not a moan - that is merely a fact. So if Teresa May is truly serious about healthcare in the UK, I suggest she takes a much closer look at the whole concept of primary care before increasing the workload of weary GPs. Rather than make knee-jerk responses to the current challenges, she would do better to explore why these challenges are there in the first place.
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