GPs should do more to take pressure off A&E departments, says May

Prime minister wants surgeries to offer a seven-day service, but is accused of trying to scapegoat family doctors for chaos in NHS hospitals

Theresa May is urging GP surgeries to make more effort to provide a seven-day service as she seeks to deflect blame for the deepening crisis in the NHS.

With pressure mounting on the prime minister, amid growing evidence that hospitals are struggling to cope with surging winter demand, Downing Street issued a statement on Friday saying that surgeries should do more to ensure they offer appointments in the evening and at weekends. GP leaders reacted angrily to the announcement and accused May of trying to scapegoat family doctors for the unfolding NHS crisis.

A Downing Street source said: “Most GPs do a fantastic job and have their patients’ interests firmly at heart. However, it is increasingly clear that a large number of surgeries are not providing access that patients need – and that patients are suffering as a result, because they are then forced to go to A&E to seek care. It’s also bad for hospitals, who then face additional pressure on their services.”

Surgeries were told to extend their opening hours, to cover 8am to 8pm, seven days a week, as part of a five-year reform programme, but the government suggested that some GPs were failing to inform patients about the availability of out-of-hours appointments or to offer them at times the public wanted.

Extra funding for out-of-hours care will in future be linked to evidence that it is being tailored by doctors to their patients’ demands and making use of digital technology. Ministers are considering using the digital appointment system to monitor demand and ensure that doctors are responding.

Many doctors already feel they are struggling to meet demand with limited resources. Earlier this week, Simon Stevens, the NHS’s chief executive, suggested May was “stretching it” by claiming that the NHS was getting more than the minimum £8bn by 2020 it had asked for. He made the claim in a combative performance before MPs at the public accounts committee, where he contradicted several of the prime minister’s assertions.

Ministers are determined not to offer additional funding without evidence that the service is being more efficiently managed, and Stevens is pressing ahead with changes he has promised.

Philip Hammond, the chancellor, told the Economist earlier this week: “We don’t have any spare cash. There isn’t a pool of cash available. We’ve been asked to provide the NHS with a certain amount of funding by its own management through to 2020. We’ve done that and more and we expect the NHS to deliver within that envelope.”

Dr Chaand Nagpaul, chair of the British Medical Association’s GPs committee, said: “This is not the time to deflect blame or scapegoat overstretched GP services, when the fundamental cause of this crisis is that funding is not keeping up with demand.

“This is evidenced by the fact the UK spends less on health and has fewer doctors and beds per head than other leading countries, as highlighted by the head of NHS England, Simon Stevens, only this week. Rather than trying to shamelessly shift the blame on to GPs, the government should take responsibility for a crisis of its own making and outline an emergency plan to get to grips with the underlying cause, which is the chronic under-resourcing of the NHS and social care.”

Nagpaul pointed out that GPs already provided care around the clock through their involvement in GP out-of-hours schemes and that many practices already offered evening and weekend appointments. “However, there are examples where extended opening has been abandoned due to lack of demand,” he said. “Government funding for extended opening has also been halved in some areas.”

The Royal College of GPs denounced the government’s move in unusually strong terms and described it as nonsensical. “It’s extremely unfortunate that the prime minister is being reported as pushing forward with a misguided scheme to force GP surgeries to offer routine services from eight to eight, seven days a week, regardless of patient demand or local resources,” said Prof Helen Stokes-Lampard, the college’s chair.

“It is not the case that GP surgery routine opening hours are contributing to the pressures our colleagues in A&E departments are currently facing. GPs and our teams are also struggling to cope with increasing patient demand without enough investment and without nearly enough family doctors and practice staff to deal with it; this is a year-long problem for us, not just during the winter.

“It has never made sense to force GPs to offer services that there is little patient demand for. In many cases, practices have already had to actually stop offering extended opening hours because of a lack of patient demand for them. Blaming GPs for the crisis facing our NHS is not going to help anyone. Instead we need to start investing in our health service properly, so that there are adequate resources and clinical staff to deliver the care our patients need and deserve.”

The shadow health secretary, Jon Ashworth, said: “The Conservatives promised this in their manifesto six years ago. We don’t need more broken promises, but clear action, starting with facing up to social care needs that have been subjected to cuts of £4.6bn under the Tories. This is another example of Theresa May’s floundering in the response to the NHS crisis.”


Heather Stewart and Denis Campbell

The GuardianTramp

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