Convenience is not enough

Sir Stuart Rose is disappointed that some GPs are not even open evenings and weekends!  I mean, it’s just not convenient to come during the working day, because we are… er… working.  Well well, that’s when the GPs are working too - coincidence!

Choice and convenience - no, the NHS needs to be better than that

Whereas shop assistants at M&S have to work Saturdays, even Sundays, because that’s when people want to shop.  My word. Why do M&S employ them at weekends?  Because they have to compete with other retailers.  But the NHS doesn’t have to compete with other free health services. Isn’t that wonderful news, saving us taxpayer funders a fortune?  It’s one of the key reasons why the NHS was ranked best of eleven developed countries health systems by the Commonwealth Fund.

There is competition to provide GP services in the UK.  Looking up private GPs there’s quite a choice, especially in London, and they are getting cheaper by offering telephone and online access.  The NHS has plenty to learn from them (note they don’t waste money on versions of NHS111, they have doctors call patients).  But it’s sheer folly to compete with their paid for services, when to do so would just increase costs.  This reduces resources for all NHS patients, and will hit the poorest hardest.  Want to see your GP at the weekend?  Go private.

Now, you’re thinking, “He said the NHS should be inconvenient because it’s cheaper.”  No I didn’t.  We’ve shown that access to your own GP can be within minutes by phone, you can always see your GP the same day, and it costs less to deliver this service than the traditional model.  That’s outstanding service, and there’s no reason why all GPs should not provide the same level.  But there are limits, because extending hours costs more, harms GP and staff family life, and cuts continuity.  Continuity, the relationship with your own GP, is the cornerstone of NHS primary care, and I’ve written on why the maths means it can’t be spread too thinly.

And you’re thinking, “He said there should be no primary care at weekends, people should go to A&E.”  No I didn’t.  We’ve shown that while 60-70% of demand into GPs is acute, only around 20% is “urgent”, and under 1% is “emergency”.  We’ve seen that when access in hours is good, demand out of hours is low.  Dr Ivan Bennett in the 7 day trial in Manchester found they could not fill the weekend clinics.  Yes, there is some emergency demand at night and weekends, much of it best dealt with in primary care, but this can be done with responsive OOH services, not by having every practice open at weekends and every GP working shifts.

So, Sir Stuart, maximising patient convenience is not fit for purpose.  Try this:  the purpose is an effective and efficient primary care service, free at the point of use.


Dr Sara Cowell              #FamilyFriendlyNHS




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