GP extended hours - great in theory, but what about in practice?


I'm a GP, but like everyone at some time in their lives I'm a patient too, and I know all about the difficulty of fitting a consultation with my own GP in to a busy schedule. When most of us are trying to juggle work and home commitments, any extra call on our time is a challenge. But when you're feeling unwell and maybe scared about what's wrong with you, it's an added stress. We would all love to be able to get through to the practice without hanging on the phone, make an appointment when it suited us and see a doctor straightaway. Now the government has announced plans for GPs to work 8am-8pm, seven days a week, and consult with patients on Skype and by email.

But while routine 12-hour access seven days a week may sound like an obvious solution, it's not as easy or as practical as it sounds. There have already been huge changes in the services available to patients through IT in the last few years. In many practices, you can book GP appointments, order prescriptions and even access your medical records securely online. Automated systems mean patients can get text reminders of their appointments or let us know how they're getting on with healthy lifestyle changes. We have dedicated telephone consultations in the morning and afternoon, and our practice regularly does 100 more consultations a day in this way. Not all patients need examining, and we recognise that it's often easier for patients not to have to come in to the practice.

The average GP surgery isn't open 9am-5pm on weekdays, as some of the newspapers have suggested. Every practice I know is open from about 8am-6.30pm, and most GPs, like me, are there from 8am-7.30pm already. Lots offer extended surgeries from 7am or until 8pm on some days, and at weekends. The bureaucracy is overwhelming, and our patients have more and more needs. In the 25 years I've been a GP, average life expectancy for women has increased by five years and for men by even more. Older people have far more complicated medical problems, and they're being discharged earlier and earlier after hospital admissions. When I became a GP 25 years ago, almost all my work with patients was checking them out when they were ill and making them better. The workload on behalf of most patients has almost doubled in the last couple of decades, because so much of our work now is about disease prevention and treating conditions like high blood pressuretype 2 diabetes and raised cholesterol, to stop them causing life-threatening illnesses in the first place.

In the hours between (and before and after) the surgeries where GPs see patients, they're checking patient blood test results (I can deal with up to 100 a day); following up letters from consultants (all of them have to be checked against the patient records and changes in medication etc, and put into place); liaising with hospitals, district nurses and social services; doing home visits for housebound patients; and spending more time than ever ticking all the right 'quality assurance' boxes to prove they're doing what they're already doing.

While people with long-term health problems make up a minority of the population, they make up the majority of the patients GPs see. If GPs end up working shifts, these patients are less likely to see their regular GP - which makes a mockery of the welcome plans introduced in this year's GP contract, to give every patient over 75 a named GP.

We can't just get the existing GPs to work longer hours - the average working week is 50 hours+ already, and working any longer would frankly make them unsafe to make life or death decisions. So it means we need more GPs - but it takes 10 years to train one of those, and there is a recruitment crisis in general practice as it is. A recent survey suggested that 60% of GPs are feeling so overwhelmed with bureaucracy and increasing demands that they're considering taking early retirement.

Then, of course, there's the fact that opening a surgery for longer hours doesn't just involve GPs. Receptionists are fairly quick to train, but hospital laboratories are only open during working hours on weekdays, and if patients need investigations when they're seen, they would need to come back during those hours to get blood tests done. The costs involved in getting routine seven-day opening hours for hospital laboratories would be huge.

So what is the solution? The first is more realistic investment in general practice - in the last nine years, the proportion of NHS funding spent on general practice has dropped to the lowest percentage on record. The second is for GP healthcare professionals and patients to work together to find innovative solutions to the problems of our ageing population and their understandable wish to be looked after in the community where possible. The third is, perhaps, for the government to stop blaming every problem in the health service on GPs. This might not make more appointments available, but it would help the recruitment crisis that I see looming. GPs take a long time and a lot of government money to train - let's try to keep them.

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