Govt 'too quick' to blame GPs

Central to government efforts to improving public health and reducing health inequalities has to be an effective health service, accessible to all users at a point before conditions become chronic. Writing for politics.co.uk, Colin Cooper, editor in chief of GP magazine, outlines the barriers to improving access to primary care.

At last it seems that some common sense is creeping in to the fractious debate about extending the hours of GP surgeries.

Mark Britnell, director general for commissioning and system management in the NHS, recently announced that any extra services would be locally commissioned.

He told a conference on health service redesign that it was time for primary care trusts (PCTs) 'to step up to the plate'.

This is welcome news for GPs, with the prospect of a new option being added to the list of enhanced services that can be organised at local level.

Until now, it had seemed likely that primary care would receive an inflexible national diktat that would fail to take in to account local needs and variations.

So after months of a high-profile slanging match between ministers and the profession, we are finally edging towards a simple solution that could be straightforwardly fitted in to existing contractual arrangements. What has been the problem?

Well, most GPs would say that ministers have been using the issue as a battering ram to destablise general practice, and allow large private companies to start providing services on a broad scale.

This fits with the government’s baiting of the national media over the past year, which has seen GPs regularly portrayed as lazy, incompetent and overpaid.

When out-of-hours services were found to be failing, it was not the PCTs managing the services that were blamed, but the GPs working for them. When the closure of Saturday surgeries was reported, it was GPs who were blamed, not the government that had reduced their working week. And when a DoH survey found that ‘only’ 88 per cent of patients could see a GP within 48 hours, it was practices that were criticised for not opening long enough.

Indeed it was health secretary Patricia Hewitt who first started complaining about practice opening hours in 2005, just a year after Tony Blair had ushered in the new GP contract with official opening hours set at 8am to 6pm, Monday to Friday.

Of course, it’s impossible to generalise about the state of access to general practice because every surgery serves a unique population with individual needs.

On the ground, many practices that have extended hours to accommodate working patients and commuters have found that the extra surgeries are sparsely attended or just attract the same people who could have attended during the day. And if they needed advice from GP or hospital colleagues, or information from diagnostic services, there were few options available outside normal office hours.

The truth is that what people want and need are often two very different things. Unfortunately, the government usually panders to what people say they want.

One GP had a suggestion that he thought could solve the whole access problem, while bringing more funding in to the NHS. All it would take is a rule change to bring GPs in line with hospital doctors on private practice. If patients were allowed to see their NHS GP privately, at a time convenient to them but for a fee, the access issue would be resolved. Or so he thought.

There is a wider agenda at work here. The government clearly wants to involve private providers in the provision of primary care services but that can only be achieved at the expense of general practice. A strong profession would stand in the way of such change.

So we can safely assume that the access issue will remain in the headlines until ministers decide that the problem has been resolved.

Colin Cooper is editor in chief of GP magazine and the primary care website www.healthcarerepublic.com