By the way...GPs should ALL be based in hospitals

MANY readers will be all too familiar with the frustration of trying to get a GP appointment.

Little wonder, it seems, with a recent report finding that half of GP surgeries are closing their doors to patients during office hours.

There are historical reasons for this. When the NHS began in 1948, an immediate gulf opened up between the hospital and the community sides of the service.

To this day, general practitioners have retained the status of being independent subcontractors to the state, jealously and powerfully protecting that independence — for their own benefit.

Each practice is its own small business, so they are effectively free to open at whatever hours they choose.

But how many small businesses, even with a guaranteed workload, can expect to survive in the modern world if they don’t open during office hours for five, if not six, days a week?

When I was a trainee GP in West London, the partners I worked for were at pains to ensure that our patients received exemplary service so they did not migrate to one of the other GP surgeries in the suburb.

Competition fuelled our commitment and our energies.

Later, when I had my own practice, I was on call every other weekend for more than 20 years. While I would grumble to my wife that ‘Harrods is not open for me on Sundays’, she would remind me it was what I’d signed up for.

Of course, Harrods is now open on Sundays — a sign of just how much the world has changed.

There have been changes in general practice, too. The ever-rising clinical workload and the added burdens of more and more administration mean that though the doors might be shut, the GP’s nose will still be at the grindstone.

Yet for the patients this is not good enough. Somehow there must be an urgent reorganisation so they can see their chosen GP between the hours of, say, 8.30am and 6pm, without having to resort to the internet or A&E. In short, the 1948 model of independent subcontractor GPs is no longer fit for the modern era.

We need a revolution in the way that general practice is conducted. This means ending the independent status of GPs, closing surgeries nationwide and opening units at every general hospital, with outreach clinics where needed.

GPs should be employed on similar contracts to consultants, enabling them to be involved in the care of their patients when in hospital — party to their hospital and GP records.

They would be able to use the laboratory and other hospital facilities and, at one stroke, the gulf between GP and hospital care would be eradicated.

Vast amounts of money would be saved, the morale of GPs would ultimately improve and patients would benefit.

As the current health service crisis worsens, we have to think radically and creatively — we can’t afford not to.