Friday 26 April 2013

We can't afford a three-day-week NHS

Rather over two years ago, I encountered for the first time the out-of-hours GP service in Croydon.  I rang NHS Direct about my youngest child, who was worryingly feverish.  They eventually put me through to the duty doctor, who advised me to bring him in.

It was the early hours of Saturday morning, and I could not believe what I saw when I got to the our-of-hours service.  A waiting room completely full of ill-looking people, some of them moaning.  It had the atmosphere of a slave ship about it - the dull acceptance on people's faces, the look of exhaustion about the place, as if they had been waiting a very long time.

There was no sign of a doctor, and the people waiting were being processed very slowly by three nurses.  While I was there, one woman collapsed in pain.  The nurses looked sheepish, and I am not surprised.  It was a third world service, for people who had been advised by NHS Direct to go in and had taken the trouble not to just turn up at A&E - which was actually downstairs.

Two doors next to each other, and I couldn't help feeling they would have been far better going to A&E.

Now I don't remember whether this was a service run by Croydoc (which eventually turned out to be run from someone's home in Norfolk) or by the social enterprise Patient Care 24, which were told in January they had lost their contract - covering three vast boroughs - as well.  That isn't the point.  The real point is that Jeremy Hunt was absolutely right yesterday to blame inadequate out-of-hours care for the 400,000 or more people who show up at A&E every week.

But there is another problem behind all this, which is the way that the NHS shuts down at weekends.  Accident and emergency services are among the few which just carry on going, though there are now weekend walk-in services.

This doesn't mean that the NHS works at full stretch for five days a week either.  In most hospitals, Fridays are dominated by preparing for the weekends, and Mondays are dominated by dealing with the weekend problems.  In effect, they are working three days a week with a buffer either side.  My local GP closes at weekends except for an hour on Saturday.

Again, it is hardly surprising that so many people do the rational thing and just show up at the service which remains in place, where there are doctors and equipment and somebody to triage them.

Of course it would be difficult moving to seven-day working right now, when resources are so tight, though it would certainly provide a more efficient service.  But GPs are paid a very great deal to provide this effectively part-time service, thanks to the disastrous 2004 contracts - one of the Labour government's greatest mistakes - and this ought perhaps be the starting point for moving towards seven-day-a-week primary care.

It is too simple to blame GPs for the current situation.  Some of them work extremely hard providing out of hours care.  But the standard of that care, certainly where I live, is so much lower than it was and GPs really need to shoulder some of the burden for putting it right.

1 comment:

fatboythin said...

My Dad was a GP in North Wales.
He used to see everyone in surgery who turned up. His evening surgery shut at 7 but he kept on until they had all been seen. Mum could see through to the waiting room from the kitchen so she knew when to put the supper on. In between he went out on house calls.
He had 2 other docs who all used to share nights and weekends.
Now you have to take a day off work and make an appointment 2 weeks in advance to see a doc.