Jayne Dowle: Chronically-ill NHS needs more than promises

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DAVID Cameron must be very careful what he promises. He says that soon we will be able to see our GP seven days a week. He vows that surgeries will stay open for 12 hours a day. For good measure, he adds that we will each be able to benefit from having a “named” family doctor devoted to our care.

“People need to be able to see their GP at a time that suits them and their family,” he says. Our own GP? At a time which suits us? No one would disagree with the principle behind all this, but when was the last time the Prime Minister found himself in a typical surgery? When was the last time he spent the best part of a morning trying to get through to even speak to a receptionist?

Most of us have enough trouble managing to secure an appointment for a week on Tuesday, never mind being able to see our doctor at our leisure. The latest GP Patient Survey, published last year, reveals that at least 10 per cent of patients seeking a consultation with a doctor or practice nurse failed to get one at all. And for those lucky ones who do achieve an appointment, the average waiting time could soon be two weeks, according to a recent survey of GPs by Pulse magazine.

Until now, I thought that Cameron was quite a rational man. However, I have to ask – is he living in a complete dream-world? He commits £400m to the scheme and pledges that it will be up and running by 2020. In just over five years?

I have no crystal ball, but I can almost guarantee that no such thing will have come to pass by then. For a start, where’s he going to find the actual doctors? We already know that the NHS has a GP recruitment crisis. According to official figures, the number of student doctors applying for GP training fell by 15 per cent last year. And to make matters worse, six out of 10 GPs are planning early retirement and one in seven is even thinking about emigrating, such is the stress of the job.

That’s why so many of us are landed with locums who have no knowledge of our problems or our family history. Not only is this worrying, it can also be dangerous. And it costs the NHS millions of pounds to employ stand-in doctors. How does Cameron propose to turn this situation on its head? He’s setting himself up for a fall. And what about the “named” GPs who remain on board? Will they find themselves working 84 hours a week just so they can be at our beck and call?

We know there is a problem, but his grand pronouncement seems to throw his Government’s ongoing negotiations with the British Medical Association into sharp relief. The family doctors’ association is already working with NHS England on a range of urgent measures to help general practitioners cope with the rising needs of patients.

As part of the latest GP contract, the BMA and the government have agreed certain key points such as releasing more funds for locums, reducing bureaucracy and appointing that named family doctor for each patient. Turning around anything in the NHS is akin to reversing an oil tanker. It takes time and painstaking manoeuvres. The last thing the process needs is a grandstanding plan which is designed to grab the headlines. And, as GP leaders continually point out, the ongoing problems in general practice won’t be solved simply by a large injection of cash. They are as much structural and cultural as financial.

Dr Chaand Nagpaul, who chairs the BMA’s GP committee, says that we must not lose sight of the relentless pressures from rising demand, declining resources and the move to transfer health and medical services from hospitals into the community.

He points out that we are now at a “critical juncture”, faced with a shortage of GPs, surgeries closing and facilities in many practices increasingly inadequate to deliver high-quality care. Only this week, the Care Quality Commission warned that around 160 practices across England could be “a cause for concern” because they are failing to deliver care of a high enough standard. Although this sounds like a small proportion out of all the surgeries in the country, their issues have the potential to affect thousands of patients.

The system is creaking at the seams because of some simple facts. The population is not only growing, it’s living longer, and older people tend to suffer from more complicated health conditions. Recent NHS figures suggest that 78 per cent of all GP consultations are for people with two or more demanding illnesses. And this group of vulnerable people is only going to grow larger and more demanding as time goes on. Would that £400m – which sounds like a lot of money now – simply disappear into a big black hole?

David Cameron must recognise that the problems in GP surgeries won’t be solved with sticking plaster, a promise and an injection of cash.

They are chronic and long-term and should be addressed as such.