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7-day Working – Deal or No Deal?
How have we got into this situation?
So the Health Secretary has promised a ‘new deal for general practice,’ including funding and investment in the workforce in return for 7-day opening. Last week, Jeremy Hunt gave a speech claiming the deal includes at least 10,000 extra primary care staff, including 5,000 more GPs and a trial of 1,000 new physician associates. The additional primary care staff will also include pharmacists, with another £7.5m to go towards supporting community pharmacists.
Mr Hunt is correct in saying “Innovation in the workforce skill mix will be vital to ensure GPs are supported in their work by other practitioners.” But how have we got into this situation? Just over a decade ago, we were handed a new contract that gave GPs the ability to opt out of the deeply unpopular night and weekend cover and saw their pay shoot up to over the £100,000 barrier. BMA GP leader Dr Chaand Nagpaul talks about it being a "hurricane" of rising patient demand, declining recruitment and a lack of investment that could lead to the end of a general practice as we know it. He has spent the past year demanding action.
We’re already doing it
Mr Hunt “needs our co-operation and support, both in improving the quality and continuity of care for vulnerable patients and delivering better access, seven days a week, for everyone.” Sadly, what he’s forgetting is that since general practices had to register with the CQC two years ago, we’re evidencing that we’ve been doing what he expects all along. Practices have been tirelessly creating and reviewing not only their policies and procedures which, thanks to Quality Compliance Systems has made it much easier for Practice Managers to do, but collating evidence of their processes that meet each of the five Key Lines of Enquiry (KLOEs).
Many practices offer extended hours early in the morning, in the evenings and at weekends and we can identify how we offer quality and continuity of care for each of the six patient groups:
- Older people aged 75 and over
- People with long-term conditions such as diabetes, dementia, CVD, COPD etc.
- Mothers, babies, children, and young people
- Working aged people, and those recently retired
- People in vulnerable circumstances who may have poor access to primary care such as migrants, the homeless, travellers, etc.
- People experiencing poor mental health
When GP practices are closed, a GP-led service is offered via Out of Hours – so what more do they want from us, with our current limited resources? Evidence already shows that those Practices offering 7-day opening have found that patients were not particularly interested and only a minority access it effectively.
Deal or no deal?
Understandably, many GPs are unhappy about the ‘deal’ and I have yet to hear a GP say they believe it’s a good thing. Many feel it is simply not possible to deliver a 7-day service for routine care in every general practice, especially when there are currently huge swathes of the country where the GP shortages are so severe that they are struggling to provide even a five day service. There is a simple way to make the ‘deal’ more attractive – attach more money to it. But, of course that’s not really an option is it? There would be an outcry if GPs pay started dramatically increasing when the rest of the public sector is being squeezed.
However, if this deal does go ahead there are ways of doing it for those who choose to. There is a trend towards practices working in partnerships with others, effectively becoming franchises. It allows for a wider range of care to be provided, something that many believe is essential to meet the needs of an ageing population. Also the federation model is increasing amongst practices and across localities.
CQC reports highlight those practices that rate as ‘outstanding’ do so because they have created appointment systems to meet the needs of their patients. Practices do well when their data can show if there has been a decrease in A&E attendances and where their appointment system had helped reduce emergency admissions when compared to local and national admission rates. If Practices struggle to offer enough face to face appointments telephone reviews could be made more available, which might also be more convenient for our increasingly busy GPs. Improvements in technology can make a huge difference in finding alternative ways of linking with patients out of core opening hours, which most patients would be satisfied with. Also, some Practices have facilities via their websites to provide a link for patients to submit blood pressure readings to the GP from their home. The key to showing Mr Hunt that we already provide an outstanding service, without having to resort to unnecessary 7-day routine working, is to initiate positive service improvements for our patients that are over and above our contractual obligations for the 71% of the week we are accessible.
Top tips for 7-day opening
If and when this 7-day opening ‘deal’ goes through there are several ways in which practices can evidence that they are already meeting the needs of their registered patients throughout the week:
- Carry out a demand and capacity survey – identify what services you are providing and when, and if they are effective
- Adapt your appointment system to meet the needs of patients – particularly where there are shortfalls
- Regularly work with multi-disciplinary teams to make sure care is being provided for patients outside practice core opening hours – evidence discussions and actions
- Actively engage with patients to ensure they know what services you provide and when – Patient Participation Groups are particularly useful to evidence this
- For patients who experience difficulties attending appointments at particular times consider offering some clinics at quieter times such as at the beginning or end of the day – to improve access and attendance
QCS GP Policies
QCS has guidance and policies to support your service in meeting the requirements of your patients and evidencing good patient care.
Alison Lowerson – QCS Expert GP Practice Manager Contributor<