Nick Summerton: GP surgery hours mean little without real NHS reform

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ONCE A month I spend an extremely productive Saturday morning meeting with our practice’s patient participation group. They’re a fantastic collection of individuals who have worked with us over the last few years to help improve the services we provide.

Thanks to them we now have a refurbished waiting room, a new website and many improved systems and processes within the practice.

One issue that’s very close to their hearts is increasing the opening hours of our practice. So I know they will have welcomed yesterday’s announcement by David Cameron’s that GPs across England are to be offered £50m of Government funding to ensure surgeries can be open from 8am to 8pm seven days a week.

I realise I shouldn’t look a gift horse in the mouth – or disagree with the members of our patient participation group – but I don’t actually want the Government to give any extra money
 to our practice to encourage us to 
extend our opening hours. Not until they have sorted out the rest of the NHS, anyway.

It’s not because my patients wouldn’t find it helpful. I know for a fact that many of them would. But while encouraging GPs to see patients 12 hours a day for seven days a week might bring in some much-needed votes at the next general election, it fails to recognise that focusing on one area of the NHS in isolation makes no sense whatsoever.

Nowadays many patients have multiple problems or complex conditions that I can’t address entirely on my own as a GP. Multi-disciplinary care delivered by teams of professionals is now the norm for everything from diabetes to cancer and heart disease.

Last week I saw a patient with deep vein thrombosis who needed an urgent assessment – but the local unit couldn’t see him for three days. Another patient with a possible miscarriage couldn’t be offered a much-needed scan for 48 hours. A third patient with a blocked urinary catheter eventually had to be sent to casualty because I couldn’t track down the specialist nurse.

Despite my best efforts I also failed to secure urgent specialist reviews for at least another three patients. At one point, in desperation, I even sent a patient in with his mother to sit outside a psychiatrist’s office.

If I was attempting to address any of these issues at 7pm I can guarantee that the problems I now encounter between 9am and 5pm would pale into insignificance.

After 5pm most routine NHS services are closed. If I’m lucky I might have the option of leaving a message on an answerphone to be picked up the following morning. Prescriptions will also prove challenging to dispense if local chemists don’t extend their opening hours to match those of practices.

Last autumn I spent a couple of weeks on the Channel Island of Alderney which showed me how the system could work.

For a fortnight I was accessible to patients for 24 hours a day and was able to spend a lot more time with them to sort out their problems.

If I had any questions or concerns that were beyond my ability as a generalist I could have an immediate conversation with a specialist on Guernsey at any time without having to navigate my way past difficult junior doctors, stroppy specialist nurses or obstructive hospital administrators.

One evening I was in the hospital at Alderney, unable to decide if a young girl had a wrist fracture. The X-ray was transmitted electronically to a consultant orthopaedic surgeon on Guernsey who was then able to give me some immediate and helpful advice over the phone.

The private sector is also catching on to this idea of developing more convenient healthcare that’s centred around the patient. The other week a private healthcare company asked me to review two patients over the phone.

Both consultations took place in the evening after I’d been sent the results of some investigations that had taken place the previous weekend. One of the patients subsequently needed an urgent specialist opinion that I was also easily able to arrange that same evening.

So, for the record, I agree with our patient participation group and the Government that it’s right to seek to extend GP opening hours.

It’s just that without changing the working practices of the rest of the NHS, it’s really nothing more than a pointless public relations exercise.

Dr Nick Summerton is a GP in East Yorkshire.