Opening hours crisis – time to stop blaming GPs?

Following the wave of negative headlines last week, which highlighted the shortcomings of GP opening hours, GP View Editor-in-chief Dr Mark Newbold, shifts the focus to the root of the problem and the strategies that will help to address it.

Yet again there is more in the press about GP opening hours, precipitated this time by a PAC report. Some coverage is critical, stating that ‘millions are failed by GPs who shut in the afternoon’ , although the report itself aims many of its recommendations directly at NHS England. This will further the impression amongst GPs that they are being put under increasing pressure to ‘perform’, without seeing any acknowledgement of the staffing and  many other challenges they face.

Just as I did when put under similar pressure as a hospital chief executive, I find myself wondering what the thinking behind this approach might be? Call me naive, but it seems unlikely that a problem will be solved unless the root cause is identified and addressed?

Adopting a strategy of ‘piling on the pressure’ can only be logical (and likely to succeed) if the cause of the problem is insufficient commitment or effort? I do not believe this to be the case, in hospital or primary care, so surely this approach will only alienate GPs even further?

Ongoing improvement work 

I see lots of evidence that GPs are working hard to improve services, despite facing unprecedented recruitment difficulties and pressures on clinical time. All over the country groups are coming together to innovate and work collectively to try and ensure that general practice, as the public like it, is maintained and able to both survive and thrive.

There is now some financial support for these ‘at scale’ solutions through the GP Forward View. This will be crucial if these new approaches are to develop successfully because in general practice, unlike hospital or community Trusts, there simply is not the headroom to move forward otherwise. GPs rightly prioritise their time to see patients, so even attending meetings is difficult as cover must be arranged, and paid for.

Finally, tempting as it is in a crisis, we must avoid drawing the wrong conclusions. I frequently hear that the present crisis in general practice is an indication that the era of self-employed practice is over. But I see no evidence that the situation would be any different if, say, an employed model was adopted? For this to be a viable solution, it would have to be more attractive to new recruits than the current approach?

Lessons learnt

An employed model of general practice may suit some individuals, but there is a real risk of losing all that is good. In hospitals, the goal is always to try and embed accountability for service quality and performance as close to the front line as possible – not always easy in a ‘top down’ organisation running on a corporate model. In general practice partnerships we have this already, through practice-based partners. It is well established and it is priceless.

In hospitals, we have long had ‘tiered’ responsibilities amongst consultants who are clinically of equal status. Lead clinicians, clinical directors, and so on are well embedded. A similarly mixed approach in general practice, whereby partners run the practices and those who prefer to have a purely clinical job opt for employed status, should cater for individual preferences and work equally well?

Partner-based general practice might need a little refinement, and salaried jobs could sometimes be made more attractive, but we should learn the lessons from other sectors and cherish what we have. Only then can general practice provide the much needed strong foundation to the new integrated providers that are fast coming down the track.

Reports like this one should be used to shine a light on the root causes, and thereby generate solutions. Using them as a stick to beat general practice can only make the problem worse.

Mark Newbold, GP View Editor-in-chief 

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