COLETTE DOUGLAS HOME
It is astonishing that GPs are to close surgeries for eight days over holidays
WHEN I read stories criticising the NHS I remind myself how lucky we are to have it. We must never lose sight of the fact that our National Health Service, open to all and free at the point of need, is a treasure beyond price.
Our bank accounts may be in the red and our prospects on the skids, but for the price of a phone call we can access highly qualified medical professionals to patch us up and put us back on track.
In most countries of the world – and before 1948 in this one – such a service would be beyond imagining.
At the sharp end of it is the general practitioner. The person who gets to listen to our moans and groans day-in, week-in and month-in. Who could begrudge them a break? This festive season, I could. I find it astonishing and disillusioning to read that their surgeries will be closed for eight days over Christmas and New Year.
It’s lovely for them to spend time
Why must they shut up their surgeries right across the country at the most frenetic time of the year – just when we are likely to need them most? It beggars belief.
with their families. But why must they all do it at the same time? Why must they shut up their surgeries right across the country at the most frenetic time of the year – just when we are likely to need them most? It beggars belief. What next? Will the police force decide to take a holiday en-masse? What about the fire brigade?
I am sure road gritters would prefer to stay indoors with hot turkey and mulled wine – and what about those stalwart electricians who sometimes spend the festive season up a pylon in the cold and dark?
Thankfully, most of the people we rely on to keep the country safe and well demonstrate a greater sense of duty. That includes hospital doctors and nurses who are working through Christmas and New Year? Won’t the absence of a regular GP service add to their burden?
The problem arises this year because Christmas and New Year each fall just before a weekend.
It turns the GPs’ customary two day bank holiday closure into four days at a stretch. This leaves the population reliant on an out of hours service accessed via NHS 24.
More than 80,000 calls are expected so extra nurses and call handlers have been recruited.
The Royal College of Emergency Medicine Scotland is predicting out of hours appointments will quickly reach saturation point after which people will turn up in A&E.
The Royal College of GPs chairman in Scotland, Dr Michael Mack, seemed at first to be genuinely surprised that the closure was an issue.
GPs, he said, took only five bank holidays a year: a day at Easter and two days each at Christmas and New Year. This has been the case since 2004, so why the concern now?
When I pointed out that the doubling up effect of a weekend tagged onto both Christmas and New Year, he conceded that obviously it was going to provide some challenges.
He went on to point out: “Since 2004, GP contacts have risen by 2.5 million across Scotland to 24.2 million a year, despite a fall in the proportion of NHS funding going to general practice from 9.5 per cent to 7.8 per cent.”
What he is saying is that GPs are working hard to maintain a high quality service against the financial odds. No one is disputing that. That is not the point.
The current dispute is about leaving most patients with only out of hours and emergency cover for such long stretches of time. GPs are professionals. They have responsibilities over and above those of ordinary mortals because they hold the health of the nation in their hands.
As a responsible profession, is it beyond their combined wit to work out a rota? I know no such demand is written in their contract, but what professional person sticks to the letter of their contract (and yes, I’m sure they will say that in many other ways, they don’t)?
Might half of GP practices have agreed to run surgeries on the Saturdays? Wouldn’t that be the responsible – not to say the caring – thing to do?
It is happening that way in Lanarkshire, where the local health board has now negotiated to pay £350 plus 10p per registered patient for the extra sessions.
Grampian put out a similar plea, but only one practice agreed to open. I call that shocking.
I would point Scotland’s doctors to the website of the British Medical Association and a highlighted statement from the general practitioners committee which reads:
“As GP practices prepare for the Christmas and New Year period it is vital that patients have access to the appropriate services, especially at a time when winter pressures are putting a severe strain on urgent and emergency care services, including general practice, accident and emergency departments and out of hours providers.
“We believe that GPs should maintain reasonable services for patients throughout Christmas and New Year period.”
Is being unavailable for eight days out of eleven a reasonable service?
I’m not living in some Dr Finlay time warp. I don’t expect doctors to work around the clock.
But although they are contracted to the NHS, I think most of us expect them to engage in strategic planning to optimise methods of working in concert with other health professionals.
As a patient I would hope for a joined-up health service so that when hospitals are likely to be under increased pressure GPs might lean in to take some of the strain.
The fault isn’t theirs alone. Health boards have calendars too. They could see this situation looming. I find it reprehensible that they didn’t combine forces to negotiate an arrangement with GPs months ago.
For it seems that some of those taking a holiday from their surgeries are working anyway. A spokesman for NHS Greater Glasgow and Clyde said it “has a very robust GP out of hours service which is mainly staffed by local GPs”.
In other words they are doing freelance shifts .
Dr Sian Tucker, clinical director for NHS Lothian’s Unscheduled Care Service, said: “GPs are independent contractors who are fulfilling contractual obligations and NHS Lothian provides the out of hours service to ensure patients can always get primary care when they need it.”
If this arrangement is safer, cheaper and more efficient than opening GP surgeries at one of the most chaotic times of the year, it begs the question, do we need the surgeries at all?
I think we know the answer. Of course we need them. With pressures on hospitals ever growing, we need them more than ever. And we need them all year round.