Richard Vautrey: Patients are victims of hospital pass

You won’t find a doctor anywhere in Yorkshire that will disagree with this idea, but a report from the Common’s Public Accounts Committee raised a significant question mark over whether policy-makers have really been listening to doctors and patients well enough on how to make this important aim achievable.

The key findings of the investigation are that we’ve seen one initiative imposed upon another over the past 10 years, leading to an array of chaotic services that often don’t link together, have wasted money and have just left patients confused.

NHS 111, the troubled phone line that collapsed on launch, is still not functioning effectively across England. According to the report, a third of the public have never heard of it.

Walk-in centres, which were launched with much fanfare and imposed on every area of the country whether they were needed or not, have in many areas been here today and gone tomorrow. They’ve been closed, such as one in Leeds city centre, because they were too expensive and duplicated existing services – exactly what doctors said in the first place. 

More recently, the Prime Minister’s Challenge Fund was launched, with yet more fanfare, supposedly to extend opening hours of GP practices. However, despite the political spin, only a small number of areas have received funding and even that only lasts for a year. A recent analysis by the BMA found that if the level of funding allocated to the six practices taking part in Wakefield was rolled out across the country it would cost the taxpayer over £1bn a year.

The traditional out of hours GP services have been very much maligned, but still in many areas delivers care that according to a recent Care Quality Commission report is highly valued by patients and still delivered by local GPs. Four out of 10 GPs for example work in some capacity in these out of hours services. The problem is that whilst funding has been spent on other politically motivated schemes, the GP service has been starved of resources, leaving the doctors working in the service under unacceptable pressure. 

The key characteristic that links all these services is that they all strive to deliver the same type of service to the same type of patient. It is not surprising then that the public is confused where to turn to and all too often take the easy but wrong option and go straight to A&E. 

But there are also other worrying negative impacts that stem from this messy arrangement. Too often these services operate in isolation from one another and the communication between them can be poor. For patients, this fragmentation means that the care they get is unlikely to be holistic and give them the complete range of treatments they need. Financially, it also does not make sense to have all these services sucking up vital resources offering the same kind of care.

More widely, general practice as a whole is struggling from a combination of rising patient demand, falling resources and a growing shortage of GPs. These problems are putting pressure on weekday services and limiting the number of appointments GP practices can offer to their patients. A knock-on effect to GP out of hours services is inevitable.

So how do we address these problems? The clearest approach would be firstly for policymakers to stop coming up with new, headline-grabbing schemes and to build on what already exists. We need to rationalise services so that we don’t have different arms of the NHS doing the same thing and distributing the funding in a haphazard manner. 

Just as importantly, we need to take a wider look at the level of investment in community services, particularly in general practice. If we want to provide a comprehensive offer to patients outside of hospital, we need to invest in the core foundation of the NHS so we can take on more GPs and other staff, and develop our premises to better meet patients’ needs. 

Patients deserve the best care and we need, as we move further into the 21st century, to provide this in a flexible way that reflects the fact people’s working lives and lifestyle are more diverse. Policymakers seem to accept the premise: what they now need to do is deliver the practical reality so that their promises can be achieved.

• Dr Richard Vautrey is a GP in Leeds and deputy chair of the British Medical Association’s GP committee.