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GPs too overstretched for 12-hour, seven-day access – RCGP

The GP workforce is too overstretched to deliver all the prime minister’s ambitious plans to deliver more flexible access to every patient by 2020, the Royal College of General Practitioners (RCGP) has warned.

At the Conservative Party Conference in Birmingham, David Cameron promised that everyone in England will have access to GP services seven days a week, with surgeries open 12 hours every day to relieve the growing pressure on hospitals. This would cost £400m over five years, he said.

But one GP said a “back of the envelope calculation” noted that this would be about £28 a practice per day. “That won’t pay for the receptionist, let alone anyone else”, he said, noting that it would therefore necessitate more ‘federations’ of practices. The end result would definitely not be care from a personalised, named GP – breaking a separate government pledge.

The RCGP, which welcomed the investment pledge for greater flexibility, warned that the plans will not mean 12-hour opening hours for all surgeries.

Dr Maureen Baker, who was elected chair of the Royal College in 2013, said: “It is important to realise that this plan will not mean every surgery is opening eight to eight, seven days a week.”

She said that in order to achieve the PM’s ambitions, the government would also need to ensure the recruitment of thousands of additional GPs.

Although Cameron has pledged that there are 5,000 more GPs in the pipeline, the RCGP estimates that the profession will need at least 8,000 by 2020 just to continue to deliver services on the basis of the existing hours GPs are contracted to provide.

“To meet this new aspiration practices will need to collaborate in federations,” said Dr Baker. “Whilst we feel this allows greater flexibility of workforce and premises, it will mean that patients cannot expect access to their own practice or their own GP for these extended hours.”

This is also in contrast to the new changes to the GP contract, which promise that all patients in England, including children, will benefit from having a named, accountable doctor who will be responsible for coordinating their care.

Dr Baker added that practices in each community need to tailor their opening hours to meet the needs of local people, rather than pursuing seven-day opening for the sake of it.

“Newspaper headlines implying that all patients will be able to walk into their local surgery in the evenings or at weekends merely raise expectations that general practice cannot live up to with the resources we are currently being given,” she said. “Whilst a welcome start, further significant investment has to follow to ensure that general practice has the resources to meet rapidly increasing patient demand.”

It was also suggested that the prime minister’s announcement does not tackle the challenges of caring for an ageing population increasingly living with multiple long-term conditions.

Nigel Edwards, chief executive at the Nuffield Trust, added that while the Conservative’s rightly recognise that local leadership is the best way to improve out of hours care and make use of new technology for access to clinicians.

“There is a danger that easier access to GPs will actually lead to greater pressures on the system, leaving fewer resources for the most vulnerable groups like frail older people,” he said. “Although the government hopes this initiative will reduce emergency admissions, evidence suggests longer hours may result in people with minor problems, who might not have gone to the NHS at all, using the service.”

Dr Baker concluded that the College supports the prime minister’s aspiration to extend access for patients, but this has to be matched by a properly-costed investment plan for general practice and an action plan to rapidly increase the number of GPs.

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