The NHS already offers a 24 hours-a-day, seven day-a-week primary care service.
However, it doesn’t offer a 12/7 routine care service. The concern is that this lack of routine care outside of the current 52.5 hours-per-week GP contract is driving up A&E attendance and thus hospital admissions.
It is true that attendance at A&E has a direct correlation with hospital admission but is there an inverse correlation between GP opening hours and A&E attendance?
The government thinks so but A&E attendance peaks in the hours that correlate to standard GP opening hours in the week, with the peak demand being on Mondays.
Peak attendance time in A&E at weekends is also between 8am and 8pm, hence the reasoning that routine 7 day opening of GP surgeries between 8am and 8pm would reduce A&E attendance.
The question is; if it doesn’t reduce demand in the week why would it at the weekend?
We know that patients of practices that offer a Doctor First-type access system have a 20% lower A&E attendance rate, even if they do not offer extended hours of opening, compared to practices offering a standard way of working.
The key difference is that Doctor First–type practices deal with true patient demand whereas practices offering traditional 10-minute appointments manage to satisfy only around 75% of that level of demand.
The answer, therefore, is to manage true demand.
Would patients use a routine Saturday and Sunday GP service? The answer is ‘yes’, but anecdotally it is often by people who could attend in the week. In addition, patients generally have better things to do with their weekends and evenings (as shown by the rise in A&E attendance on Mondays).
To cope with this additional opening with an understaffed workforce fewer sessions would need to be provided in the current standard working week. That would inevitably mean that patients would be just as unlikely to see their own GP as they are now, which would defeat the object of the Government promise that patients would have increased access to their own GP!
There has been no suggestion that the extended GP service would replace the out of hours service and that begs the question of why we would benefit from paying for an extended hours service twice?
SO what might be lost? With the 2004 GP contract perhaps the single most important factor in improving patient safety has been the abolition of an individual GP’s 24-hour responsibility for patient care.
That guaranteed time-off has allowed doctors to recharge their batteries and so be in a far better situation to give of their all in the day.
Having said that, there is no new money to pay for these additional hours. Some money has been recycled from GP contracts to pay for additional hours and so many GPs may decide that they want to offer a seven day service to try to claw back some of that lost income.
How can the practice be set-up to most efficiently offer the service? We know that Doctor First soaks up the weekly demand and so demand is reduced in the evenings and weekends.
We will see if patients choose to use their weekends to see a GP for routine problems and Doctor First practices such as Salford Health Matters will lead the way in finding out what effect weekend opening will have on their weekly workload and what the true demand for weekend appointments is.
It will then be for the Government to decide whether the duplicated additional cost is the best use of those scarce NHS resources.
Dr Stephen Clay
GP and Clinical Director for Productive Primary Care Ltd