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Out-of-hours provides opening for politics without planning

1 November 2007

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Tom Brownlie
AMSPAR Chief Executive

Once again, the end of year is nigh, and we can turn to reflect on the months gone by. It seems no time at all since we walked into the office and took down the Christmas decorations we couldn’t be bothered to tackle as we stumbled out of the office clutching the bags of presents that we still hadn’t delivered. So what are the significant differences that have transpired in the days since then?

Yes, we have a new prime minister, and he has taken the “unusual” step of commissioning a report on the NHS. In fact, we came fairly close to the possibility of a third prime minister in a year just after the conference season. It was only when the current incumbent realised just how feasible this was that we were informed that there would be no “snap” election after the months of speculation.

But the conference season did allow the various parties to parade their wares and tempt us with their plans for health.

Political posturing
In Blackpool, Shadow Health Secretary Andrew Lansley called the Conservatives the “party of the NHS” in his speech to the assembled members at their conference. Party leader David Cameron spoke of a “personalised NHS”, making “the NHS and doctors answerable to the patient and not to the politicians … the way we’ll get a really personalised NHS is to make the changes that are necessary: giving people a real choice of GPs; giving GPs control over their budgets; and allowing GPs to choose between whichever hospital they like.”

Down in Brighton, Sir Menzies Campbell, the then leader of the Liberal Democrats, accused Labour of creating an NHS “culture of boom and bust”, and called for the government to “take back our NHS”.

Over in Bournemouth, Gordon Brown, in his first speech to his party as leader and Prime Minister, said: “We know that being unwell is not just a nine-to-five problem. And so we will make GP hours more friendly to families, open up opportunities to see a GP near your place of work as well as your home, expand walk-in centres, medical centres at pharmacies, and ensure a better service from NHS Direct.” He also coincidentally talked about a “personal” NHS.

While a UK general election was not called, elections were held in Wales and Scotland. While the former didn’t change the hue of the Assembly, the latter did have significant ramifications, with the Scottish National Party forming a minority government for the first time ever.

It immediately made its mark by abandoning several A&E closures, which were planned on the basis of UK NHS policies. There was also the announcement of the intention to bring Scotland into line with Wales in terms of free prescriptions.
It is quite clear that the previous cosy arrangement, between a Labour-led parliament in Hollyrood working hand-in-hand with their colleagues in Westminster, has gone for the foreseeable future. Key areas such as health and education will see a greater divergence in the years ahead.

Opening move
One common theme that ran throughout the conferences was that of access to our GPs (or lack of it), and what could be done to improve the situation. And again, it was addressed in Lord Darzi’s report, issued in October, Our NHS, Our Future.(1)

After backing a more personalised NHS, saying “I also have come to the view that the NHS could benefit from greater distance from the day-to-day thrust of the political process, and believe there is merit in exploring the introduction of an NHS Constitution,” he went on to the subject of greater access to GPs: “Primary care trusts (PCTs) should introduce new measures to develop greater flexibility in GP opening hours, including the introduction of new providers.”

In conclusion, he stated: “Our aim is that, over time, the majority of GP practices will offer patients much greater choice of when to see a GP, extending hours into the evenings or weekend.”

Practice hours and practicalities
While the extension of hours may be laudable, what is seldom addressed are the resources required to achieve this aim. We are all too aware of the struggle of consultants in keeping within the European Working Time Directive. One assumes GPs are not being asked to do additional hours, so this will mean closures at other times for the smaller practices.

And why do we only say GPs? A practice relies on many other staff in order to function. Will the receptionist be appropriately remunerated to do “unsociable” evening work? What of samples collected in the evenings? New timetables will have to be drafted, and again resourced.

In a recent position statement on primary care and GP access, the NHS Alliance argues that additional costs should be funded: “Real costs to extending GP practice opening hours include practice staff and overhead costs that are separate from doctors’ pay. It would not be reasonable to expect practices and their staff to subsidise PCTs’ legal responsibilities for out-of-hours care. Additional costs should be funded.”(2)

When the current General Medical Services contract was being negotiated, few predicted that many GPs would not seize upon the option of opting out of out-of-hours – and who can blame them? For the government to now want to go back and rewrite the contract smacks of incompetence in the first place.

Of course, we all want care and treatment when it is needed, and of course the staff want to give of their best for the benefit of the patients. But this cannot happen if the practice is overworked and under-resourced. Coherent planning is required to meet this objective – not simply leaving the door unlocked longer.

1. Department of Health. Our NHS, Our Future: NHS next stage review – interim report. London: DH; 2007.
2. NHS Alliance. Primary Care and GP Access: an NHS Alliance position statement. London: NHS Alliance; 2007. Available from: