Seven day services – does the dream match the reality?

It can be no surprise the GP lobby has reacted angrily to David Cameron’s plans to introduce seven day services by the end of this parliament. If most of us were asked by our employer to change our work pattern to include working at weekends and to 8 o’clock at night, we would probably have something to say about it. But the facts are stark. Falling ill is not a career and doesn’t happen during normal business hours, hence you are 16% more likely to die if admitted to a hospital at weekends.

This fact is rightly being used as the catalyst for introducing a 24/7 NHS and at the acute end of the spectrum there has been an acceptance for some time of the need for weekend services (despite a current stall in consultant contract negotiations).

However the real issue in primary care is access. Pressures on the urgent care system have risen due to restrictions in out-of-hours services and patients view the A&E department as the new face of the NHS. To this regard the Government’s plans for seven day services, beginning in primary care and eventually moving to all NHS services, are both commendable and necessary.

The fact that the GPs are pushing back against David Cameron’s plans may be underpinned by self-interest but there are some serious questions that the Government has yet to answer. It is widely accepted there is a currently a chronic shortage of GPs, with many practices closing having been unable to fill positions of retiring partners. Struggling to cope with current demand it is hard to see how an expansion of services can be filled during the current recruitment drought.

Simon Stevens, NHS England Chief Executive, has this week waged war on staffing agencies who he claims are “ripping off” the NHS with exorbitant fees for temporary staff. Whilst Mr Stevens is expressing a valid concern regarding the amount the NHS spends on agency staff, there is the underlying issue of agencies filling gaps whilst the next wave of nurses are currently being trained. It will not be lost on the Health Secretary that nurses take three years to train whilst a junior doctor takes seven, making his ambition to recruit 5,000 more GPs by the end of the parliament seem increasingly difficult to achieve without mass overseas recruitment.

GP contract reform is currently on the table and the Government is playing a balancing act between striking a realistic settlement in times of austerity elsewhere, and similarly attracting more candidates to the profession whilst retaining those it has spent significant time and resources in training.

A seven day service is an ambitious programme and patients deserve to ask that the NHS they pay for should be truly equitable and not a lottery of time or location. Despite this, demand has already outgrown supply. If we want to achieve this ambition we must first start looking at ways of diversifying primary care beyond treatment delivered by a GP. If we don’t there will be a lot of waiting rooms full of patients on Sunday afternoons without the treatment rooms ready to accept them.