Dear Patients of the NHS,
You might have seen some headlines in the last few weeks about doctors being angry, disagreements between the doctors union the BMA, and the Government. There have been petitions, Facebook letters, Twitter campaigns flying around. All of this may have passed you by. Or you may have registered the headlines and thought "well, a seven day NHS makes a lot of sense. Why don't doctors want to work at the weekend like everyone else?"
Doctors from the newly qualified juniors, to Consultant and GPs have been up in arms about the new proposals. I could tell you in exacting detail why they are. I could quote NHS contracts, working time directives, funding allocations, GMS and PMS statistics at you ad nauseam.
It was my father who pointed out to me that this was the wrong approach. He isn't a doctor. He's a retired teacher. He knows about the NHS as a patient, and as the father of a doctor, but he doesn't know anything about the ins and outs of the contract negotiations. So when I said to him I didn't know how to help the public realise why this was such a big deal, he cleared it up for me.
"People only know the headlines. They don't know how it will affect them as an individual patient. If they do, they will care."
So this is my patients guide to what all the fuss is about. And what I think it the solution. First the doom and gloom.
1) You can't get a GP appointment - this is a warning of things to come.
I am guessing that you have seen a significant change in your GP practice in the last five years. Maybe it's harder to get an appointment. It might be a longer wait - two or three weeks to see a doctor. You might not know who your GP is anymore. Or there are a lot of doctors leaving your practice and locum doctors when you go. If you know your GP well, you may notice how busy they are, and that they are looking strained. Or that your GP doesn't work full time anymore - it's because they are struggling to cope. If you are in certain parts of the country, you may have heard of GP surgeries closing nearby. You might have lost your local practice.
General practice is ahead of the rest of the NHS in its problems. It has been brewing for longer there, which is why patients are noticing. All of this is due to not enough doctors choosing to be GPs. There just aren't enough to meet patients' needs. They aren't choosing to be GPs because the workload has shot up, and the pay has dropped. I could argue all day about GP pay - in fact I have in a previous article. But for the purposes of this, just believe me that we don't get paid anywhere near what you think, and however much we do get, it still isn't enough to make young doctors want to do general practice for a living.
2) Patients are backed up in A&E, waiting on trolleys. Hospitals are breaching their waiting targets and declaring major alerts.
As GP surgeries have come under pressure, so have hospitals. This was particularly bad last winter, but there are ongoing alerts from hospitals across the country even during the traditionally quiet summer. When the decision is made to admit you to hospital, there needs to be a bed for you to go into. More unwell, complex patients are being admitted to hospital. These patients have medical needs, but also social needs. When they are medically ready to go home, unless the social care is also in place, they can't be discharged. Social care cuts mean this isn't getting done quickly enough. The beds are not free for new patients coming in, and they end up having to go to A&E to get their treatment started. This blocks A&E so hospitals miss the four hour waiting target, and anyone but the sickest patients has to wait longer.
3) On this background, the government has called for seven day services
With all this going on, the government announced they wanted GPs to offer routine appointments to patients seven days a week, and hospital consultants and junior doctors to have their contracts changed to do the same. Now lots of different reasons were given for this, but I'm trying to keep to the key points about why this is a bad idea:
- There is nothing to show that these changes need to happen. All of the headline figures presented to back up this argument have been widely discredited
- There aren't enough GPs for you to be seen now. How will your surgery manage the increase in workload if they open for an extra two days a week? Can we expect patients to wait four or five weeks for an appointment?
- there is already a GP NHS service available at evenings, overnight and at weekends, 365 days a year. It is called the Out of Hours service and is staffed by GPs. Opening routine surgeries simply duplicates the existing service, wasting money.
- Consultants already work seven days a week on call, including routine work. A Freedom of Information request too all hospital trusts has so far shown that of 23,918 NHS consultants, 0.24% opted out of routine weekend working. The majority of this tiny amount, who did opt out, did so in order to get around European working limits on their hours. Put simply, 99.76% of consultants work seven days a week, with the remaining percent choosing to work extra hours by a significant amount. This is not the picture being painted to the public. For example, a Consultant surgeon will be on-call for 24 hours a day from Monday to Friday, or Friday to Monday. During this time they will do their normal clinics and ward rounds, but also be available for emergency cases that are admitted and need operating on. This might be during the day; it might be in the middle of the night. A consultant surgeon friend working last weekend performed six major operations (laparotomies) each taking an average of three hours to complete, and countless smaller surgeries (operations for appendicitis, burst abscesses, gallbladder problems) as well. This is under the current contract. Hardly a bad deal for the NHS.
4) Would you let a pilot fly an aeroplane after a 90 hour week?
Under the new contract, all junior doctors (everything from a brand new doctor straight out of medical school right up to a senior registrar who is just about to start their consultant post) will have their hours altered. The new contract will make their "normal" working week last from 7am to 10pm, Monday to Saturday, increasing from the current 60 hours, to 90 hours. If you are admitted as an emergency; if your husband, wife, daughter, son is rushed to hospital desperately ill - do you want the doctor looking after them to have been at work for 15 hours already that day? Do you want to know they have already worked for six, 15 hour days in a row? Does that reassure you that your loved one will get the care they need and nothing will be missed? There are no breaks built into these shifts. No time to eat, drink or sit down. In 2000, changes were introduced to stop exactly this. Recognising that it wasn't safe for doctors to treat patients after working excessively long hours, the regulations were tightened. Hospitals were forced to alter their rotas to comply. But now it's suddenly safe to let an exhausted surgeon operate on you.
5) How do you get more doctors to solve these problems? Cut the pay you offer.
This new contract gets rid of most of the unsocial hours pay that doctors received. All hours worked between the 7am-10pm Monday to Saturday are paid at the same standard rate. Doctors who change the area of their training will be demoted back to the most basic pay scale, and in the area of most need, general practice, GP trainee pay will be cut by a third. That is not going to help recruitment. All medical graduates have paid maximum tuition fees for their own education, graduating with an average debt of £75,000. They must undertake compulsory NHS foundation training to be licensed to practice, and few countries or private companies are interested in employing doctors who haven't done significant training already. It goes against common sense that in a time of shortages across the NHS workforce, instead of continuing to stop pay rises, pay is actually being cut.
All this should matter to you as a patient, because your care is not as good as it could be. If these changes go through it will be worse. Your safety is being put at risk. My greatest fear is that nothing changes, the NHS slowly crumbles, stretching more and more, doctors too tired to concentrate, patient care suffering, safety put at risk. You as a patient know this from your experiences every day. If the NHS is going to survive for the future, all of us - patients, public, professionals and politicians, need to accept that it isn't working. We need an honest discussion about its future. We need to start talking.
Next time you go to your GP, ask your doctor if the surgery is struggling to cope. If you go to a hospital clinic, ask the doctors and nurses there. Write to your MP. Tell them you are concerned. Speak up about what you have experienced locally, and why you want it to change.
I'm declaring my agenda now - I am part of a group called NHS Survival. We want an independent Royal Commission set up to look at the future of the NHS. It would hear evidence from patients, staff, think tanks, experts and politicians. It would recommend how to safeguard the NHS for the future, and how to protect its patients. No hidden agendas. No vested interests. If you want to know more, visit nhssurvival.org and have a read.Suggest a correction