THE BLOG

Seven-Day NHS Pledge Faces Age-Old Issue

26/05/2015 15:46 BST | Updated 25/05/2016 10:59 BST

There is one story dominating healthcare headlines right now - the government's pledge to deliver "a truly seven-day NHS". It's a commitment we all welcome in principle, but with dwindling GP numbers, tight budgets and concerns over existing primary and secondary care workloads, it has prompted a collective eyebrow raise and the question, 'how'?

Greater support for GPs, local community services and analysis of NHS staff working patterns have already been pledged, with more detailed plans to follow in the coming months. But in all the furore, one important question has been surprisingly absent from most of the debate. Namely, where is the demand for NHS services actually coming from?

It isn't from patients with 'one off' conditions who can be seen, assessed, treated and sent on their way. It is from patients with long term health conditions, which currently take up around 70% of the health service budget.

Four million Britons now suffer from diabetes, with treatment costing the NHS £1 million an hour; 2.3 million are living with coronary heart disease and cases of osteoarthritis are set to reach around 17 million by 2030. The King's Fund estimates that by 2018, 2.9 million people will suffer from three or more long term conditions - known as multi-morbidity.

Unsurprisingly, the long-term conditions are most prevalent in older people, with 58% of over 60s suffering from one or more long-term illnesses. Given that Britain's over-65s now outnumber those under the age of 16 for the first time, and that by 2035 the 'dependency ratio' (the number of people of working age in relation to retirees) is predicted to be 2.5 to 1, demand on the NHS for long term conditions is only going to increase. An aging population is the single biggest challenge facing the NHS.

So what does this mean in terms of seven day services? For me, the wider adoption of best practice in joined-up care is imperative. Patients with long term conditions have multiple NHS 'touch points' i.e. their care is rarely provided by just one doctor or one community nurse or one pharmacist or one hospital clinician; it is delivered by a team of healthcare professionals across a number of services. For these patients, it's not just about accessing anytime services, it's about continuity of care.

Without the systems in place to share and update patient data (with patient consent) among 'the team', there will always be inefficiency and scope to improve care - no matter how many days a week the services are offered.

With the systems in place, unnecessary consultations, appointments and treatment admin can be reduced to free up doctors, nurses, A&E teams and specialists - but more importantly, it enables care to be delivered in such a cohesive, collaborative way that patient health outcomes actually improve. It's about helping our healthcare teams to work smarter rather than for longer.

Importantly for the seven day pledge, sharing real-time patient data and treatment plans between healthcare professionals opens up much greater potential to pool collective resources.

Take Manchester. There, thanks to a data sharing agreement project, patients from 34 practices are able to access an increased range of specialist primary care services, at extended hours, via 'host practices'. Essentially, GPs are able to offer their patients more services with greater flexibility within existing resources - all while ensuring continuity of care.

It's a project that exemplifies comments made recently by GPC chair Dr Nagpaul, when he stressed the need for GPs to be "creative about new ways of working and using technology to ease pressures".

Dr Nagpaul also called on GPs to work "with other health professionals such as pharmacists" to support their "daily work load". This is absolutely a valid call to action and is a route to achieving seven day service access without having to re-invent the wheel. It is already happening - but it will only become 'the norm' with the right support for secure, shared use of patient data.

Those who need and use the NHS most should never have to worry about what day of the week it is. They should also never have to worry about those treating them being out of step with the latest developments in their care. The good news is that these needs are already being met by existing technologies and projects such as the Manchester host practice system. The opportunity is to build on these foundations to benefit all.