The government seems to be in the process of having a fight with GPs over lengthening their opening hours. The Health minister is writing to GPs to try to appeal over the heads of the BMA, though judging by the sample taken by the BBC the GPs are behind the BMA. The GPs appear to have agreed to open for an additional two hours but the government is demanding three. The government has been pledging to increase GP access for some time and has been angered by the increase in the pay for GPs which can now be over £100,000.It may be popular to have GP surgeries open at times more convenient for the working population which will inevitably mean outside normal office hours. However, most people seem relatively satisfied with the current arrangements The GPs’ seem in principle prepared to do this but have suggested that if they are forced into an agreement there could be resignations from the NHS; the GPs also fear creeping privatisation of NHS General Practice.
Whilst cynics might suggest that the fear of privatisation stems from the danger of a loss of control for the GPs, the current model of General Practice in the UK has frequently been held up as The Crowning Glory of the NHS, and is widely credited with reducing the overall cost of health care as compared to for example the French system whereby patients can attend practically any doctor from any speciality.
The current system clearly has significant problems over access. One must remember, however, that the current GP contract allowing them to opt out of out of hours care for patients was introduced due to grave fears that General Practice had become unattractive for young doctors and that this would result in an inadequate number of people being willing to go into it. The new contract was indeed a great success for the GPs, and was even better than their negotiators had expected. This crisis in recruitment has been solved but that was at the expense of paying doctors more and improving their working hours.
The current government strategy may be popular with many working people. The reality is, however, that such people rarely need to attend the GP and when they do so it is usually for easy to sort out conditions. As such, for them, seeing a GP in say a supermarket as some have suggested might be acceptable; whether or not that would provide an interesting and stimulating career for a GP is, however, a very different matter. It would also run the grave risk of people seeing multiple different doctors and as such a serious and dangerous progression of an illness being more likely to occur undetected; a situation which can already occur with tragic consequences in the current system. The more chronically ill, often with complex problems are the ones who most need to see a person who knows their case well and indeed are the patients whose care will be most interesting for GPs to provide.
The other problem is one which I have highlighted previously with regard to the dentists. GPs like dentists are self employed and unlikely as it may sound one supposes that there could be circumstances whereby GPs might at least in part opt out of the NHS as the dentists have done. It is conceivable then that the result of a government show down with the GPs might cause a partial ending of the current system. That is probably too alarmist but as I mentioned above the reason for the new GP contract was fears that there would be inadequate numbers of GPs. Whilst some rebalancing is probably possible the government might do well to remember that if they antagonise the GPs enough it could have disastrous consequences. Unless of course their aim is genuinely to end the current system and introduce private health providers to general practice; that surely is too Machiavellian?