http://m.bbc.co.uk/news/uk-politics-29415929

Another load of bollocks by DC. There are 65000 GPs in the UK. £100m per year is £1500 per GP. How many of you would work an extra 20 hrs per week for an extra £30? Furthermore, the practices that have agreed to a pilot programme have had £50m of funding and still haven't started 7-day access. Finally, the highest users of GP services are children and the elderly, neither of whom want or need 7-day access.

What would make more sense is to have more GPs so you can provide a decent standard service. On top of this, out of hours services are largely staffed by GPs. More than this, you would need to increase and improve the rest of the services. No point opening GP access if those GPs can't do bloods, send for tests or admit patients at the weekends. You would need to have more practice staff as well.

In summary, load of bollocks that isn't gonna work.

IN' be needed a doctor once at the weekend in my life. That was when I had a severe gout attack and I lived deep in the countryside of Bavaria. There there is always an emergency doctor on call at the weekend. A neighbour drove me the 20KM to the doctor for an injection.

A friend visited me and had a bad asthma attack in the middle of the night at the weekend. The emergency doctor came out and gave him an injection.

That sort of service is fine. In an emergency, where it isn't practical to go to the hospital - the nearest was around 40 - 50KM away.

I've never has the need to visit a doctor at the weekend for a 'casual' problem.

The problem is the endemic idea in current UK society that we are all 'customers' and therefore have a right to whatever we want, when we want it. Rather than seeing GPs as a communal resource we all use as necessary, there seems to be a view that 'I'm paying for it so it has to dance to my tune and sod everyone else'.

As a result we're spending billions of pounds providing on-demand services when in fact that demand doesn't have to be met immediately.

It's another side effect of the idea that 'the market' is the be all and end all and the best solution to every problem.

And we have the same here. There are doctors who cover out-of-hours - they cover telephone calls, home visits and see patients at primary care centres.


Completely agree and see this often. There's this "me, me, me". On the one hand, a patient will lambast GPs as nobodies who just hand out antibiotics. Yet that same person will complain that the GP didn't give them an antibiotic for their cold.

I've had a bit more of a read in the Guardian newspaper:

http://www.theguardian.com/society/2014 ... ry-cameron

So pulling it apart.


I've already stated above that this is far inadequate. It won't even cover costs of hiring staff (like receptionists, healthcare assistants and nurses).


This could easily be done but means you can't then prebook an appointment. I know some surgeries that just have open surgeries. You turn up and queue and will be seen. You might have to wait all day. The main reason for having an appointment system is so that you minimise time wasted by waiting.


In practice this would mean having to have staff (and not just doctors) in the building before 8am until after 8pm. In a large practice, this might be feasible. In a small practice like mine, it won't be possible.


Before the new contract, every GP was responsible for a list of patients (approx 2000). So you would see only those patients. Then the Govt came along and tried to break the link between a GP and a patient. Suddenly, all patients were registered with a practice, but not with a GP. Now we're suddenly back to having a named GP.


I've pointed this out before but the highest users are kids and the elderly. Neither really needs specific weekend access unless for emergencies. At which point the out of hours system exists.


Waffle and means nothing.

NHS expenditure in primary care has been dropping year on year. It used to be 11% of the NHS budget. Now it's 8%. So with less money, GPs are having to do more, work longer and harder. Secondary care are dumping lots of patients back to primary care for two reasons: to reduce their own workload, and to maximise income through new referrals. Case in point - I saw a 10 year old girl yesterday. She was under the care of orthotics at hospital. She sees them regularly for her foot problems. They've now discharged her and want a new referral. Why? Because they'll get more money for seeing a new referral than seeing a follow up.

Even if GPs worked longer, what about the rest of the system? Not much point in seeing patients if i can't then take their bloods, send them for investigations or refer to social services if the rest of the system is still running "9-5". The entire NHS was built on the premise that patients get 24/7 emergency care and 9-5 Mon-Fri routine care. If you truly want 24/7 routine care, you have to rebuild the system from the ground up. You need to pump billions in to build new surgeries, hospitals, rehab places, staff, social services etc. The whole thing would need to be revamped.

I have a sneaking suspicion this is yet another preamble for 'The NHS can't cope so let's get in private healthcare which, being 'private' will by definition be more organised and efficient than the lazy, feckless public sector, to do the job instead'.

Cue 'if you want an appointment now, that'll be 20 quid. If you want one for free, it'll be next week'.

You may well be correct. I have felt that they're trying to destroy general practice and are struggling as GPs have been coping with the workload more and more. But now surgeries are closing and older GPs are retiring rather than staying on ( a combination of revalidation, loss of seniority pay and more paperwork), doing 8-8h 7 days a week would destroy small practices. This leaves the larger ones more ripe for being bought by private companies.

I think I need to retrain in something else other than medicine. Not sure what.

Can't see it happening. How many GP's stopped doing night calls when they could? Can't see many agreeing to start working weekends

All those private companies that are queuing up to dismember civilized society will need to hire consultants with anatomical experience. You can become an angry, disillusioned, consultant with an a drink problem if you try really hard.

I genuinely LOLd

Two things. Firstly a lot of GPs still do night calls. The whole out of hours service has GPs.

Secondly, things have changed. In the prehistoric days, a GP would rarely be called out at night. When the nhs was formed, they figured a gp would only ever do two visits per patient - one routine and one to certify death. The cost of this at some point was deemed to be an extra £6000/yr. Over the years the workload increased. GPs were allowed to link with other practices to provide out of hours cover. So you could have say 10-15 GPs each taking turns. But the workload kept increasing. It got to the point where GPs were on their knees.

There was a huge recruitment crisis, GPs were leaving or retiring early. Morale was low. Pay had deteriorated and not increased with inflation. There was negotiation for a new contract. GPs were to be given a pay rise but to do so would be a public outcry so it came in the form of QoF. Basically GPs got money for targets which they were mostly hitting anyway. At the same time, the Govt felt it could do out of hours for the same cost of £6000 per gp per year.

Over the past decade, the income has dropped year on year. The workload has massively increased. There's been dumping of secondary care work on GPs as well as new paperwork, all of which detract from the GP role. If you compare GP life in the past, a GP might do a morning and an evening surgery, with home visits in between but there was always time for a 2-3 hour catchup nap. Paperwork was limited to referrals. Now as well two surgeries, and home visits, a GP spends the time in between doing govt derived paperwork. On top of this, out of hours services arent always properly run. A consortium of GPs can offer to bid to run the out of hours services but most are undercut by private companies who can't meet the needs and bow out.

If you look at access at our surgery, we offer a walk in service from 1800-1830. In the past year I've seen maybe five people. The demand just isnt there. This is replicated across the country.

Up to 600 GP surgeries could close over course of next year as doctors retire
http://www.theguardian.com/society/2014 ... er-warning

I think on top of that, 200 practices are due to be closed by CQC as not meeting standards, and another 100 are at risk because of loss of MPIG (a correction factor for payment to ensure some practices weren't losing out on funding). That counts as around 900 surgeries that will probably close.

I've had a think about this. We're short of GPs. Traditionally, the idea would be to use a carrot eg "golden hello" or more attractive pay/T&Cs etc. I suspect HMG is more likely to use the stick eg cut down numbers of hospital posts in order to divert people into General Practice. So then you have a load of doctors who didn't want to be GPs now being GPs.

I think I’ll add this here, rather than starting a new thread.

Ageing GPs 'may force practices to close'
http://www.bbc.co.uk/news/health-29440139


One of our GPs has just retired. He’s been replaced, but it’s a small practice on the edge of town. I wonder how long it will be before my GP decides that he’s had enough.

Some GPs write in:

http://www.theguardian.com/society/2014 ... l-football