In the last week, GP practices across England have received emails from their CCGs (Clinical Commissioning Groups). While the details have differed, the request has not. We want you to open on Easter Saturday. To "relieve the current pressure" on the NHS. This is an example of the utter stupidity that drives me, and the majority of other staff in the NHS mad. Let me explain why.
Clearly, the Easter of 2015 has taken everyone by surprise. The preceding centuries of this public holiday have obviously provided no clue, and the fact that routine NHS care is not offered over Bank Holidays has been missed. You can imagine the frantic meeting between Jeremy Hunt and Simon Stevens, Head of NHS England a few weeks ago.
"Minister, I have just been passed this memo - there is a national emergency in the NHS. It's taken us totally by surprise. We don't have any contingency plans in place for this "Easter" phenomenon. There will be no routine medical care for 4 days. 4 days!! What shall we do?"
"Well, given the emergency situation, we will have to ask for extra help from NHS staff. Ask all CCGs to email the GP practices. See if - given the exceptional and unexpected nature of "Easter"- they would consider opening to provide extra capacity. Dear Lord, how can this have happened?!"
Well Mr Hunt, clearly it has. So with a month to go until the Easter weekend, out goes the email. GP surgeries are being offered extra funding to open on Easter Sunday. There is money to pay for both doctors and staff. I'm sure none of them will have made plans with their families. And they will have to open because of the guilt, that otherwise their patients will be left with no medical care whatsoever.
What Mr Hunt and Mr Stevens seem to have conveniently forgotten, is that there is a GP service available. It is available every night, every weekend, and every bank holiday across the whole of the UK. It is called the Out of Hours service. It is staffed by GPs, nurse practitioners, and dedicated staff who are trained and equipped to deal with medical problems outside normal hours. It is linked in with NHS111, the Governments own health advice line, and it is designed to reduce demand on A&E so that only true emergencies are dealt with there. Money for this service is already allocated, including to provide extra capacity over public holidays. The number of doctors available is flexible, and more shifts can easily be added at busy times of the year such as Christmas and... Easter?
So NHS money is already being spent on providing a GP service out of hours. CCG's have had the shifts arranged for months (it's called forward planning you see), the staff booked and the rotas done well in advance. Despite what NHS England and the Department of Health seem to think, EASTER IS NOT A SURPRISE!
It is another huge example of waste in the NHS - that the Government purport to be so against - to then be giving GPs up and down the country extra money to open and provide the same service. I can see the headlines now from the right-wing press... For once they have a point. Why has this money not been given to Out of Hours if there is concern about demand? The service is set up and in place. Why are GPs in the south of the country, being offered more than those in the north? Are they not as qualified? Should their staff working over a bank holiday not get the same rate of pay as colleagues elsewhere doing the same job? A service is being duplicated because the last thing that any politician wants to read just before a General Election is headlines like those seen over Christmas - another crisis in the NHS, hospitals declaring major alerts, patients lined up on corridors. The NHS is a political tool, and it makes me so angry that NHS England are playing this game, instead of arguing that the scarce resources should be diverted to where they are most needed.
Perhaps if the Government hadn't tried to reduce spending on the NHS111 service by bringing in non-clinical call-handlers because they are cheaper than the nurses and doctors which NHS Direct used to provide, then the 111 service would be fit for purpose, and wouldn't call an ambulance for every patient who rings for advice about their cough?
Perhaps if they hadn't thought they could save money and run an Out of Hours service more cheaply than local GPs were doing in the first place, making the targets and triage so complex that doctors doing their own became largely unfeasible, then they wouldn't have so little confidence in the existing set up that they want to have normal practices opening as well?
Perhaps if they properly funded General Practice instead of cutting away at the budget while pushing demand with consumer driven expectations, there would be enough doctors to see the patients in the days before the bank holiday, to have robust plans in place for any issues over the weekend, and the only people needing to access Out of Hours would be those with truly acute problems?
Can the Department of Health not see that they are making a damning indictment of their own system by suggesting this, and that they are wasting tens of thousands of pounds in duplicating a service that already exists? THIS is an example of waste and bureaucracy in the NHS. THIS is an example of why political parties should not be allowed to make the NHS their personal campaigning tool.
What is lacking is a long-term view in the NHS. Policy and decision making, the running of it as an organisation, even what names are given to each part. Every five years the NHS gets on the General Election Merry-go-round, and every five years, it comes off as something different than it went on as. All the targets are short term, because in four and a half years' time when the campaigns for re-election gear up again, the parties need figures, they need claims to back up how wonderful their running of the NHS has been. Short term investment for long term gain is woefully lacking in the NHS. Unpopular public health measures are avoided; truly tackling obesity, smoking, alcohol and drug use is dabbled in with the odd campaign and project.
Having an honest debate about the future of the service, backing professionals to challenge inappropriate use, making sure the public accepts responsibility for their health and that the expectation is you will do everything you can to keep yourself well - none of it is done. What would the long term impact be if everyone with mental health problems were given the access to evidence-based talking therapies that Nice recommend? What would happen if all those patients at high risk of developing diabetes and heart disease, received targeted support to maximise their lifestyle changes? How many patients who are signed off on long term sickness benefits could return to work if money was invested in the right, individualised support for them? If health education was compulsory from reception, and children were taught the basics of healthy behaviour, where to access medical care for common problems, why antibiotics don't work for almost all minor illness. If money was invested in alcohol and drug rehabilitation, coupled with social care input, could the cycle be broken for some of those who eventually cost the most to the NHS in the long term, let alone police and other services?
These aims are dismal failures in the short term for governments. They are not vote winners. They cost a fortune. They require significant levels of investment to then demonstrate savings 10, 15, 20 years down the line. No amount of reorganisation or renaming will achieve this.
So if your GP practice suddenly opens on Easter Saturday, don't think this is a good thing. This is another step in the litany of decisions made to undermine the NHS so that it fails. It is failing already and when it does, the government will wash their hands of it, and we will all be paying for private healthcare. Thanks Mr Hunt.
This post has been edited to correct the Easter references.