Open all hours? Not if you want a better service

Published on Monday 3 March 2008 21:12

A LOT has been written about extended GP surgery hours in the past few months, and currently the British Medical Association (BMA) is polling its members on the way forward.

However, I want to look at the issue from a different perspective – from a personal point of view as a patient.

Fortunately I do not have to go very often to my GP, but is important for doctors, be they consultants or GPs, to have their own medical adviser so that they avoid treating themselves or relying on colleague who they work with.

However, I live 12 miles from my own place of work, leaving home at 7:15am each morning and not getting back home until 7pm, so a visit to my GP means taking a half-day's holiday leave. I would therefore welcome the opportunity to get that 7am slot or the 7:30pm evening appointment with my GP, or even be seen on Saturday morning. I believe many other patients who work full-time would also appreciate the opportunity to see their doctor without eating into their holiday allowance.

The problem is that all this hype in the media about extended hours is turning the change into much more than it is, raising public expectations to a level that is not realistic. People are starting to imagine that the new GP service is a 24-hour service. It is not. In reality, what is being proposed is only a very small change that most patients will hardly notice.

Take my own practice of 10,000 patients as an example. We offer some 500 doctor appointments each week. In addition, there are midwives, health visitors, practice nurses, phlebotomists and dieticians in the practice, each also offering appointments.

Under the Scottish Government's proposals my practice will be open for an additional five hours, and will have to offer 20 appointments in those hours. These additional appointments will be provided by one doctor in rotation. That means one doctor working in the surgery without any members of the primary care team or reception staff there to provide further appointments or other support.

Also, these new appointments are not much use if you are pregnant (there are no provisions for midwives), need an intimate examination (no chaperones) or need access to diagnostic services (this service doesn't operate at evenings and weekends).

And if you have a problem that requires investigation or a chronic condition that requires a blood test, then don't come in during these extended hours as there are no laboratory services available.

It will need considerable education and explanation to ensure that patients understand that they may have to return to the practice during the week when the full service is available to get the necessary proper investigation and treatment.

So a panacea for all this extended hours plan is not. Some practices may decide to take the financial hit and not offer these proposed extended hours. It will be particularly difficult for small practices of one or two doctors to offer this service safely. I don't envy the doctor in his surgery at 8pm on a winter's night with an aggressive or disturbed patient to sort out.

There needs to be some common sense built into the proposals – these appointments should be protected for patients who are working and have real difficulty accessing their GP – but how? Sadly the model that GPs in Scotland are being offered is the Gordon Brown solution for the difficulties being experienced in south-east England.

Hopefully, even at this late hour, we can persuade the Scottish Government to come up with "Scottish solutions for Scottish problems" (haven't I heard that before from the lips of our health secretary?).

So, while I expect extended hours will happen, one thing is certain: if GPs are asked about whether the way that this change has been introduced encourages trust and respect for politicians there will be a resounding "no". That message will be a permanent legacy that our political masters will have to live with.

Anyhow, I look forward to seeing you in the surgery on Saturday morning – if all the appointments haven't been taken by those I already see during the week.

&#149 Dr John Garner is a GP in the Lothians and member of the BMA's Scottish council.