I love the series Yes, Minister and Yes, Prime Minister for many reasons, among them the timeless, elegant dialogue that can be applied to today’s politics.
Hearing the pledge emanating from Number 10 that very soon the UK will enjoy a ‘seven-day a week GP service’, conveniently devoid of any details as to how that service will be funded, staffed or brought to fruition, I am reminded of the following exchange:
“Humphrey, I’ve been thinking.”
“I’m sure you will agree that so far my Premiership has been a great success”
“Yes, and I’ve been asking myself what I can do to continue this run of success.”
“Have you considered masterly inactivity?”
“A PM must be firm.”
“Indeed. How about firm, masterly inactivity?”
“No, Humphrey; I have an idea,”
“Excellent, Prime Minister!”
A seven-day GP service is such an idea; it will allow healthcare delivery to match changing working hours, give those people working shifts or long hours during the week the opportunity to seek healthcare at convenient times and decrease wait times in Casualty.
By being able to see their GPs round the clock, patients will receive greater continuity of care and value for their taxes. More cancers and heart disease can be discovered and referred on for specialist care, improving the UK’s woeful record in this department. Who in their right minds would be against such an empowering, and wonderfully generous pledge?
Nine per cent of total expenditure on the NHS is spent on General Practice, though 90 per cent of NHS contact occurs at that level. During the period 2008-2012, percentage expenditure went down from 10.5 per cent while the number of consultations per GP increased from 9,000 to almost 11,000 per year. Despite this, over 30 million patients failed to get an appointment with their GP last year.
There are currently 8,000 GP practices with over 300 million appointments given in the last year. Each practice has on average 8,000 patients on its books with an average of five consultations per patient per year.
GPs do not work out of hours, but most work a 12-hour day, sometimes seeing up to 60 patients.
Forty per cent of GPs find the current heavy workload unsustainable with 30 per cent considering leaving the profession and 25 per cent considering emigrating.
Burnout as a result is a real problem with our GPs; one survey of GPs reports that 80 per cent of practices have a GP with burnout. Hands up who wants to be seen by a burnt out doctor?
According to the Royal College of General Practitioners, another 10,000 GPs are needed by 2020 to meet current requirements, let alone those of a rapidly increasing (open-door immigration) and unhealthy population (thank you, obesity, diabetes and hypertension).
So let’s take stock: not enough GPs to run the service, not enough funding, not enough hours in the day, a workforce that cannot see themselves coping with the workload or stress and wanting to either take early retirement or emigrate before the job consumes them. What an encouraging picture!
Who will now volunteer to work weekends? Who will sacrifice their right to a family life? Where on earth are we going to get the extra numbers needed? Are we going to bribe medical students to become GPs and then castigate them for their ‘high salaries?’ Bring in overseas doctors and then complain that they can’t speak English?
Let’s pretend that a detailed commitment to funding was suddenly to issue forth from Number 10. Where, in the age of austerity, is the money to come from? (One could argue that with levels of immigration as they are, we could raid the foreign aid budget with a clear conscience and spend it on the NHS.)
Even if the total NHS budget increases, GPs will only get nine per cent of it. Will this extra funding pay for the expansion of GP surgeries and increased GPs that will be needed? What about the extra nursing and admin staff (some of whom will be on the dreaded zero-hour contracts, or have children and be unable to work weekends)?
Will GP practices now try to recruit single women without children and then be forced to defend lawsuits under the Equalities Act if they refuse to employ working mothers who cannot work the weekends? With a seven day service When do we expect our GPs to update their skills and knowledge and be au fait with the latest evidence and guidelines? What about attending family events?
Let’s pretend that all is well with the seven-day-a-week GP service; will the hospital budgets increase to cope with the larger number of referrals that will be made from primary care given that more patients will be seen? Will we get more staff to interpret the higher volume of tests? How will the longer waiting lists for surgery and to be seen in specialist clinics be dealt with? Will we have to involve the private sector to tackle waiting lists? Will we stop funding certain procedures?
This gimmicky manifesto pledge was ill thought-out, and when it is finally abandoned as unworkable, I imagine the exchange will go something like this:
“I can’t abandon this pledge. A Prime Minister must show that he’s arrived; he must show there’s a new mind and a firm hand at Number 10. He must be seen to have made his mark”.
“But you have, Prime Minister”.
“You taxed pasties, Prime Minister; something your predecessors never accomplished.”
Dr Tarek Arab is Assistant Professor of Obstetrics & Gynaecology
at Jeddah University School of Medicine