Much debate is currently underway, fuelled by the press, amongst politicians of every hue, on the future of the NHS. Whilst this is a vast subject that has taxed many great minds (and incomes) over the past six decades; the part regarding General Practice and specifically access to General Practitioners has been particularly prominent of late. To paraphrase, it seems that most of the problems regarding overwhelmed A&E departments, lengthening hospital waiting lists and incompetent out of hours' providers can be simply solved by getting GP surgeries to provide a seven day service by opening evenings and weekends.
Can GPs working evening and weekends reduce demand on other parts of the health service? Of course they can. But is it realistic to get GPs to open their surgeries evenings and weekends? Again yes since GPs have always adapted to whatever government initiative have been thrown at them. But is it truly desirable and who actually would man those surgeries? Now that is where this debate should begin.
Twenty five of my years as a doctor involved night and weekend work. I, like most of my colleagues, hated doing it. That is why we walked away en masse when given the opportunity to do so in 2004 by the GP contract of that time. We did not take that decision lightly and it was certainly not made through avarice. The reason was almost entirely due to one word, 'exhaustion'. The problems prior to 2004, lack of manpower and incentives, are worse today. When I was on call all night; I still had to work all the next day. There was not enough money to bring in someone to cover for me even if such a white knight had been available. Thus I would return to my surgery after a sleepless night on call and attempt to deal with the influx of patients with all their problems in as sympathetic and efficient manner as possible. In truth there were many times when the service I provided must have been substandard. Hopefully no one suffered because of my tiredness but serendipity should not have any part to play when one is dealing with other people's health.
Seven day working seems to make sense until you recognise that there still are not enough doctors or the money to pay them to cover for those doctors needing that day off in lieu. If anything the crisis in manpower has worsened because now GP surgeries are closing down through lack of partners and I have never come across that situation in my entire working life.
We have ample evidence from the long history of the NHS that the more you increase supply and access; the more you increase demand. We have as yet not found a way to break out of this equation. If we continue to make unsustainable promises to the public then we will be faced with a potentially infinite amount of work but with a diminishing and finite workforce to manage it. If you remove one person temporarily from the front line then his/her duties have to be managed by those remaining. Without a dramatic and unsustainable increase in resources/ funding this will not happen so we are left with an increasingly overwhelmed, stressed, tired and demotivated workforce. This is particularly undesirable in an environment such as clinical medicine where we really need our practitioners to be on the ball all the time since we are relying on them to manage a vital part of our lives; our health. Either we accept, as a society, a trade-off between convenience and safety or we choose the status quo. That is the debate we need to have not the ones being placed before us by politician's specious sound bites.