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Cameron pledges delivery of seven-day GP services by 2020

Prime minister David Cameron has pledged to deliver seven-day GP services by 2020 through a new “voluntary” contract.

The GP contract will seek to integrate general practice with community nurses and other healthcare professionals to provide “seamless, person-centred care”, under a new contract to be introduced by April 2017.

It will be voluntary, with federations or practices that cover populations of at least 30,000 patients. Practitioners who join it will continue to work in local neighbourhood surgeries and health centres, but will be able to join forces with neighbouring GPs to form these federations and work closely with other healthcare professionals.

The contract will be offer on a “phased basis”, starting with groups of GPs that are closest to being able to implement seven-day schemes.

Under his plans, Cameron also intends to roll out week-long hospital services to half the country by 2018. Patients admitted to hospital in an emergency any day of the week will be assessed by a consultant “as soon as possible and no more than 14 hours after arrival”.

If they are in a high dependency ward they will be seen by a consultant twice daily, and if they are on a general ward, they will be reviewed at least once every 24 hours – a standard only 10% of hospitals currently meet.

Patients will also have access to diagnostic tests throughout the whole week, such as x-ray, ultrasound and MRI, in addition to any urgent, consultant-led treatment necessary.

Cameron also intends to make it a “requirement” that NHS England and CCGs ensure every patient has access to seven-day services. Further details on how this will be delivered will be revealed in the coming months.

Scrapped bureaucratic processes

According to Whitehall, the new contract will include more money for primary care, more control for GPs over the way they work and more time to care for patients.

It will also remove the “bureaucratic box-ticking of the 2004 GP contract”, the “micro-management” of their work through the Quality and Outcomes Framework and “other sorts of old-fashioned bureaucracy”.

This follows a new report by NHS Alliance that found that around 27% (or one in four) of GP appointments could be avoided if there was more coordinated working between them and hospitals, wider use of primary care staff, and better use of technology to streamline “administrative burdens”.

Cameron said: “Our plans for a truly seven-day NHS will transform services for millions of patients. It will offer hardworking taxpayers and families the scrutiny of the care they need at a time that is convenient to them.

“I know they face huge pressures – that is why we will direct more money into primary care and clear out bureaucracy as part of the drive to develop a new contract that will be better for patients and NHS professionals, seven days a week.”

He expects that injecting more money into primary care will relieve pressures on A&E and other struggling emergency services.

This will be met with a £750m grant over the next three years to fund improvements in premises, technology and modern ways of working, such as supporting federations and larger practices in providing week-long services through face-to-face, telephone, email and Skype consultations.

But this grant will be subject to a bidding process, with applications received by the end of the year and the first schemes announced in 2016.

Although a number of hospitals already deliver seven-day care, Whitehall wants to tackle the “far too much variation” present in this system.

By 2017, one-quarter of the population who have urgent or emergency hospital care needs will have access to the “same level” of consultant assessment, diagnostics tests and consultant-led intervention every day of the week.

The NHS now also has the “concrete objective” of achieving 50% population coverage to those standards by 2018 and complete coverage by the end of this parliament.

BMA lashes out at ‘undiscussed’ plans

Although the government has said that it “listened to GP leaders who say that the time has come for a new contract option”, the BMA said the announcement was not discussed with its members.

Dr Chaand Nagpaul, its GP committee chair, lashed out at the proposals, commenting: “Yet again, the government has chosen to rely on soundbites during the Conservative Party conference rather than actually addressing the fundamental issues facing general practice and patient care.

“This announced, which was not discussed with the BMA, does nothing to address the root causes of the pressures on general practice; escalating patient demand from an ageing population and care moving into the community, crippling underfunding and a chronic shortage of GPs. Nine in 10 GPs state that workload pressures are damaging the quality of patient care.

“The government must learn from its own pilot schemes where there have been a number of examples of weekend appointments having little or no pick up by patients. These proposals could waste precious NHS resources and divert staff and funds from overstretched core GP services.

“GPs already provide around the clock care, seven days a week – we need this to be properly staffed and funded rather than undermined.”

He added that getting rid of the box-ticking system is something the BMA has “long been calling for”, but that it must be applied to all practices – not just those considering the new contract.

 “Crucially, we ne do not need the diversion of a new contract, we need proper levels of investment in GP services, and thousands more GPs and staff to keep up with the sheer number of patients coming through the door in order to provide safe, quality care,” he added.

And Dr Mark Porter, BMA council chair, said Cameron has not been clear on how he intends to staff and finance seven-day services at a time of “enormous financial pressure on the NHS”.

He added: “The additional money that has been pledged for the NHS is barely enough to keep existing services running and will not pay for additional care.”

Heidi Alexander MP, shadow health secretary, also criticised the announcement by saying that Cameron made "exactly the same" pledge at the last three Conservative Party conferences and the last two general elections.

She said: “Each time he’s promised it, he’s failed to deliver, so why on earth should we believe him now? The truth is that as attractive as these plans may sound, they are simply not credible without the extra resources and staff the NHS needs.

“Patients are struggling to see their GP during the week, let alone at weekends. People want answers to the problems they are experiencing today, not unfunded, unrealistic promises for tomorrow.”

In August, the BMA published seven questions in national papers challenging Cameron’s details for his seven-day NHS.

The association published a new advertisement today (5 October) calling on Cameron to use his conference in Manchester to “answer the remaining six questions”.  The only question answered, according to it, was in relation to focusing on the delivery of urgent and emergency care.

(Top image c. Paul Toeman)