Golden opportunity was missed on GP opening hours

Much has been written in The Herald about government plans to extend GP opening hours. Reports claim that the government will provide �£19m additional funding� to deliver extended hours.

DR DEAN MARSHALL

Much has been written in The Herald about government plans to extend GP opening hours. Reports claim that the government will provide "£19m additional funding" to deliver extended hours while business leaders claim that it is the fault of doctors, not employers, that patients cannot visit their GP when they are unwell. But this general overview of the situation is misleading. Doctors are angry, not because they are being asked to deliver extended hours, but because of the way in which governments in England and Scotland are treating the profession.

The UK government has rejected the BMA's proposals to deliver extended hours and make improvements to the quality framework of the contract largely within existing funding agreements. They refuse to negotiate with us. Instead, they have presented an offer to GPs whereby, if they do not provide extended hours, they will lose existing practice funding. If GPs reject this offer, then a worse alternative will be introduced. It is this approach to "negotiating" with a recognised trade union that has infuriated doctors.

GPs recognise that the public wants to be able to see them at convenient times - who wouldn't? Our own survey of GP opinion last year found that half of GPs would consider extending current opening hours if sufficient resources were made available, but 73% considered that it was not a good use of NHS resources.

Last year, the BMA had discussions with Health Secretary Nicola Sturgeon to discuss improvements in access to general practice. We highlighted the need for local flexibility, particularly considering the rural nature of much of Scotland. We supported the principle of practices providing more flexible surgery times within existing contracted hours (8am to 6.30pm) and, where local demand for extended hours existed (primarily in the central belt), NHS boards could negotiate locally with practices to deliver extra hours. But these constructive discussions were superseded by the UK government's plans, which were swiftly adopted by the Scottish administration.

The Scottish Government has stated that it has provided an "additional £19m" to fund the service. This is a smokescreen. The reality is that government is investing new funding of £9.5m, but a significant proportion of the funding to support their proposals is being taken from existing general practice funding.

Extended hours will be voluntary, so even if GPs agree to the government's offer, they are under no obligation to provide the service. But if they do not, practices stand to lose around £6500 of existing funding. If they do provide it, they will receive around £2.95 (only £1.75 of which is new money) per patient, but will undoubtedly have to spend more on staff.

So what can patients expect from the service? It will not be a comprehensive service comparable to what is currently available. The government proposals are based on one lone GP providing the service, so GPs are understandably concerned about safety and security for both themselves and patients. Patients will be able to come in for pre-booked appointments but there will be limitations to the service on offer. Very few blood samples can be taken because the majority of them cannot be stored in the practice overnight. Patients can't be sent for diagnostic testing because those services are not available at evenings and weekends; intimate examinations cannot be conducted because there will be no chaperone available; outpatient appointments cannot be made because hospital departments are closed; and the range of services provided by other members of the healthcare team will not be available because the government proposal only provides for GP presence.

It is obvious to many GPs that this is a badly thought-out plan. GPs believe this is a tick box' strategy and simply a vehicle to allow government to claim they have achieved a political commitment.

But surely there are better ways to deliver extended hours? If only the SNP government had had the courage to take a separate approach to do what is best for the NHS in Scotland rather than following the lead of Labour in Westminster. Working with the profession, it could have developed a proposal for extended hours that would deliver the service patients want and which doctors can deliver. The government has missed a golden opportunity.

GPs also believe that there are more worthy causes for £9.5m of limited NHS funds. The government's own priority to tackle health inequalities will not be served by these plans for extended hours. Investment to ensure access to healthcare for those with the greatest need is surely a more practical strategy. We could then address the appalling health of those from our poorest communities, where life expectancy for men is almost nine years less than in more affluent areas.