RCGP says Jeremy Hunt's plans for seven-day NHS are 'unrealistic'
NHS England has announced that it is forging ahead with its controversial plans for a seven-day service despite 1 in 10 GP positions currently lying vacant and many practices regularly relying on locum doctors, according to information from the Royal College of GPs (RCGP).
The latest RCGP survey consulted with 549 practices across England and found that 10.2% of full-time positions are vacant and 61% of these were filled on by agency or locum staff. In addition, 64% of the practices surveyed described the ongoing task of sourcing locum staff as 'difficult' or 'very difficult', both factors which the RCGP say cast doubt on the feasibility of government plans to introduce a seven-day working week for GPs.
Locum GPs are not tied to a practice and are usually brought in on a temporary basis - to cover permanent staff member's holidays or sickness or to fill temporary posts, but the RCGP says there has been an increasing number of locums staying on for extended periods when practices are unable to recruit new staff.
NHS England says it intends to recruit 5,000 more GPs in order to implement the seven-day plans by 2020, and Health Education England, the public body responsible for the planning and delivery of NHS staff training, has been tasked with ensuring that moving forward 50% of medical students choose to specialise in general practice but the RCGP says this number will be inadequate.
The RCGP is calling on NHS England and the government to instead concentrate on strengthening the existing GP workforce and ensuring the current five-day service is 'robust'. It says that 3,300 additional GPs are needed now to adequately meet current patient demand, before future demand and GP retirement is even considered.
Growing patient demand
The RCGP says GPs and their teams carry out 60 million more patient consultations than five years ago, with a total of 370 million made each year, and estimates that an additional 8,000 GPs will be needed by 2020 to continue to deliver the existing five-day service and out of hours and to meet this growing demand. It says GP workload has rocketed as a result of a growing and ageing population in the face of a static GP workforce, while the share of the NHS budget in England has decreased year-on-year to its current all-time low of 8.4%.
It says the current service would also benefit from improved support for and integration with out of hours GP services and says steps should be taken to raise awareness of existing services - the latest GP Patient Survey revealed that only 45% of patients know how to gain access to an out of hours GP.
Chair of the RCGP Dr Maureen Baker says: "We are in dire straits if we do not act to address the GP recruitment crisis immediately and ensure that there are enough GPs in the system so that practices do not have to run with a substantial number of vacant positions.
"Our new research brings home how difficult GP practices are finding it to recruit new doctors and retain existing ones. It is simply unrealistic to be thinking about seven-day working when our existing five-day service and out of hours GP services are under so much pressure.
"Many GP services are already offering extended hours. However, opening for extended periods is pie-in-the-sky for many family doctors who are already working exceptionally long hours in clinic to cope with demand.
"Locum doctors do an excellent job, and provide an essential service for patients. Working as a locum can also be a productive career path, particularly for young GPs, as it gives them a wide experience of the diverse challenges of general practice. But the government and NHS England must ensure that the pendulum swings such, so that practice-based work is always seen as the main career choice for most GPs.
She adds: "The government needs to move away from its obsession with 'providing a seven day NHS' and do more to implement the joint 10-point plan to build the GP workforce and 'recruit retain and return' thousands more GPs as soon as possible, so that we can provide a good, solid and safe five-day service, and out of hours service, for our patients. Routine seven-day working may improve patient safety in hospitals but in general practice it could have the opposite effect."
Ros Roughton, Director of NHS Commissioning at NHS England says: "We know GPs are under immense pressure. The level of investment in the NHS has not been matched in terms of investment in primary care. There is variation in quality of care, and despite high levels of satisfaction, we have seen a drop in access.
"But work is underway to respond to these challenges. We’ve increased funding allocations for primary care, we have workforce initiatives underway, there is £200 million worth of Prime Minister’s Challenge schemes in train and we have just announced a new occupational health service to support GPs.
"Currently GPs are doing things that other professionals can be doing. It’s about using nurses, pharmacists and other professionals to take the pressure off GPs."
Why a seven-day service?
The concept of a seven day service has been the subject of much heated debate over the past few months, with many NHS staff reacting angrily to what they percieve as criticism for not working hard enough or for opting out of weekend working.
The debate surrounding the idea, first proposed in 2013 by NHS England's Professor Sir Bruce Keogh, was reinvigorated by David Cameron on behalf of the Conservative party in the run up to this year's general election when he pledged to deliver " a truly seven-day NHS by 2020". The concept was partially borne out of debate surrounding the review by Keogh of mortality data from the Department of Health. The data, based on information relating to 14.5 million patients and gathered in 2009/10, appeared to suggest a 16% increased chance of death within 30 days for those admitted to hospital via Accident & Emergency on a Sunday and an 11% increase for those admitted on a Saturday, in comparison to those admitted on a Wednesday. Conversely, of the 187,337 deaths that fell into this group,more people actually passed away mid-week than at the weekend.
A review of the findings, published on NHS Choices as far back as 2012, said that the study did not examine the reasons behind the apparent increase in risk of death, so "no assumptions should be drawn about staffing levels or the availability of senior staff". A new analysis based on more recent data is expected in the coming months.
Under the plans, Health Minister Jeremy Hunt proposes to end the right of consultants who work in non-emergency care to opt out of weekend shifts and to increase the number of senior staff working over weekends, both in hospitals but also across primary care settings including GP surgeries. Campaign group #weneedtotalkaboutJeremy says the way the plan is likely to be imposed is unfair and argue that only 0.1% of consultants currently exercise their right to opt out of weekend shifts.
In addition, the BBC reports that a pilot scheme launched in Scotland two years ago, which saw the number of consultants on duty out of hours increased, with the backing of senior doctors and medical colleges at the time, has resulted in an increase in consultant vacancies in the region. In addition, a study of data from Dumfries and Galloway Royal Infirmary published in 2013 found that mortality rates were higher over Bank Holidays, despite extra consultants on shift.
It has been suggested that part of the reason for this higher mortality rate may be that people who are admitted during the weekend may be suffering from more advanced illness than those who arrive during the week. This may be due to a perception that only those that are seriously ill should seek urgent medical attention during the weekend as the service tends to be busier and operating with fewer staff.
In addition, some diagnostic tests such as MRI, ultrasound and CT scans, X-rays and pathology tests are often not as readily accessible at weekends due to fewer supporting staff and any subsequent delay in diagnosis and treatment results in delayed discharge, thereby clogging up beds, resources and staff time, argue supporters of the plans.
The subject of the cost of delivering a seven-day service at a time when the NHS is under vast financial pressure still remains to be addressed by the government.
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