The Health Secretary Jeremy Hunt has reiterated his commitment, and that of NHS England, to ensuring that his seven-day NHS vision is realised.
This policy will remain in place despite the resignation of David Cameron as prime minister, and his subsequent replacement by Theresa May.
In a written ministerial statement, Hunt indicated that he expected NHS England to “make further progress on the priority of rolling out the seven-day NHS commitment including ‘to improve access to GP services, particularly in evenings and at the weekends”.
Despite Hunt’s apparent determination to continue with this policy, GP leaders have been scathing about the seven-day concept, describing its continuation as idiocy.
Hunt’s statement began by reaffirming his belief in the notion of a seven-day NHS.
“The mandate for 2015/16 emphasised that the NHS should be there when people need it; providing equally good care seven days of the week. I look to you to continue to support the NHS to deliver the same high quality urgent and emergency care regardless of when patients need to use services and to improve access to GP services, particularly in evenings and at the weekends.”
Hunt continued by underlining the longer term vision which he has for the health service.
“I welcome the progress that you have made this year and I expect you to continue working together with your system partners in order to make further progress on this priority, in line with the Government’s mandate for 2016-17 and our longer term goals for 2020.”
This commitment to the seven-day concept by the Conservative party has come as something of a surprise, particularly as prominent individuals indicated in recent weeks that there could be a U-turn on the subject.
A senior policy adviser recently revealed that routine seven-day GP appointments would no longer be a priority following the resignation of Cameron.
This was seen as very much a brainchild of the former prime minister, with Cameron having continually promoted the importance of weekend prioritisation in the health service.
Family Doctor Association chair Dr Peter Swinyard has already condemned the policy of Hunt, suggesting that it simply makes no sense in the existing climate.
“It is just confoundedly idiotic. There is no funding sufficient in the health service, there is no staffing sufficient in the health service, to provide a five-day service that is good. And to try and spread out the resources we have for providing a five-day service to provide a seven-day service is beyond ridiculous.”
NHS trusts recently announced a collected deficit in the region of £2.5 billion for the previous financial year.
The Royal College of GPs (RCGP) has responded strongly to recent suggestions from the government that the NHS should develop a seven-day-a-week culture.
Prime Minister David Cameron asserted earlier this week that by the end of the decade the whole UK population will have access to general practitioners from Monday to Sunday.
But the RCGP suggested that the aims of the government are completely unachievable in the current parliament, and could even result in existing care being destabilised.
In order to achieve its lofty goal, ministers have promised that 5,000 extra doctors will be recruited to the NHS.
However, RCGP president Maureen Baker asserts that any additional recruitment would be largely consumed by filling gaps in the existing workforce.
Encouraging the government to rethink their approach to the whole issue, Baker stated that vacancy rates within the GP profession were likely to be in the region of 10% per cent.
There are no official figures available to either contradict or confirm this impression.
Baker suggested that the NHS doesn’t have “the nurses and the support staff to do the hours we’re already contracted to do, never mind extend those. Therefore, frankly, 08:00 to 20:00, seven days a week for routine general practice is unachievable.”
Thus, it is perhaps not surprising that the president of the RCGP was of the opinion that continuing with the government’s plans in the existing climate could cause serious problems.
“The danger is that in order to provide services over those extended hours, that you destabilise other parts of the service. You’re fishing from the same pool, so if those doctors are attracted into that work, instead of out-of-hours service for instance, then there’s a risk that you destabilise the out-of-hours service so that people can come and have routine care on a Sunday teatime,” Baker asserted.
While the picture related to GPs in the UK is complicated and difficult to measure accurately, perhaps the most reasonable way to assess it is to make reference to the official GP survey carried out by Ipsos MORI for NHS England.
The results of this poll did suggest that waiting times are becoming an increasing issue with regard to GPs.
Although 75 per cent of respondents were satisfied with their GPs opening hours, this represented a fall of nearly 5 percentage points since the previous survey.
Nonetheless, the British Medical Association has also questioned the government’s policy, stating its belief that investment should be concentrated on existing services.
Despite a climate related to the issue that can reasonably be described as contentious, Health Secretary Jeremy Hunt has nonetheless signalled the intention of the government to press forward with seven-day GP opening.
Hunt indicated that he is absolutely focused on making the policy happened, and was undeterred by the criticisms from the likes of the RCGP.
As the debate about the government’s seven-day NHS plans rumbles on, senior figures from the NHS have voiced their support for the scheme.
NHS England medical director Sir Bruce Keogh described the case for GPs being available to patients at weekends as “simply unassailable”.
Keogh particularly cited research to which he’d contributed that suggested that the so-called ‘weekend effect’ was responsible for 11,000 excess deaths each year.
However, sceptics of the study have questioned how many of these deaths were actually avoidable.
The study published in the British Medical Journal claims that the findings of the researchers raises “challenging questions” about the existing NHS culture.
Keogh was one of seven leading doctors and statisticians that contributed to the research, which extensively examined hospital records during 2013-14.
The report adds to earlier research that was published three years ago.
During the period studied, nearly 16 million patients were admitted to hospitals, and an apparent weekend effects was identified by their researchers.
Admission to hospital on a Friday night to wait 2 per cent increase risk of death, with the figure of a 10 per cent on Saturdays and 15 per cent on Sundays.
This effectively equated to 11,000 access deaths over the course of a single year. Other factors such as patient health and history were also taking into consideration.
Based on the data acquired by the survey, Keogh believes that there is a compelling case for action, and that a new seven-day culture should be instigated in the NHS as suggested by the government.
Keogh even suggested that the current situation is simply unacceptable.
“Doctors up and down the country routinely go the extra mile, well beyond any contractual duty, to save and improve lives. But the idea that patients are being harmed because of the way we organise our services is quite simply beyond what any of us can regard as acceptable,” Keogh asserted.
“The moral and social case for action is simply unassailable and there is widespread clinical consensus about that. Change always brings practical difficulties that must be tackled but we cannot duck the facts,” Keogh continued.
Although emergency care and accident and emergency units are available at the weekend, staffing levels are typically significantly lower than during the week.
However, despite the assertions of Keogh, key medical leaders are still sceptical about the proposals of the government.
In particular, BMA leader Dr Mark Porter Express explicit concerns about the logistical problems involved with changing the NHS culture so radically.
“Given the current funding squeeze on NHS Trusts, the only way for many hospitals to increase the number of doctors over the weekend would be to reduce the number providing care during the week. If the government really want to deliver more seven-day services then they need to show patients, the public and NHS staff their plan for how this will be delivered at a time of enormous financial strain on the NHS and when existing services and staff are under extreme pressure.”
The current budget for NHS England is £95.6 billion and it seems certain that this would need to increase significantly if the government’s scheme to be implemented by 2020 as intended.
David Cameron has delivered a speech outlining the vision of the government for a fully functioning 7-day NHS.
The Prime Minister chose his first major speech since returning to Downing Street after the general election to outline the plans of the government for the National Health Service.
Cameron reiterated his intention to maintain the central position of the NHS in British society, while detailing Tory spending schemes for the service over this parliament.
The Conservative leader also naturally engaged in a significant amount of what can only be reasonably described as political rhetoric.
Nonetheless, Cameron stated that spending on the NHS would increase significantly between now and the end of the decade under a Conservative government.
The Prime Minister pledged to increase spending on the National Health Service by at least £8 billion per annum between now and 2020.
But particularly central to the speech was Cameron’s apparent vision of a 7-day NHS service.
The Member of Parliament for Witney made this the ultimate subject of his first major speech of this parliament, which could draw comparisons with the so-called ‘Big Society’ that was launched during the first term of the Cameron government.
In launching this vision for the NHS, Cameron made reference to the Vitality Partnership; a GP organisation that operates across 13 different locations in Sandwell and Birmingham.
Cameron claimed that Vitality are “dramatically increasing the range of services available in one place; the times those services are available and the ease of booking them.”
Clearly the Prime Minister believes that similar organisations to Vitality could play a major role in a more joined-up NHS.
Cameron spoke of an NHS that delivered prevention as well as cure, in which operations such as Vitality are able to deliver a “full suite of care services”.
There was also specific reference in the speech to making better use of commonly utilised technologies to make NHS services more accessible for remote customers.
Skype and FaceTime were particularly name-checked, as Cameron imagined a health service in which patients can be seen “without setting foot outside [their] front doors”.
The overall aim of the Cameron vision for the NHS is to deliver a service that enables 18 million patients to have access to a GP at mornings, evenings and weekends by the end of the financial year, and for this level of service to be delivered nationwide by the end of this parliamentary term.
Although this may all sound like a positive concept of how the NHS will operate in the future, the British Medical Association (BMA) was somewhat sceptical about Cameron’s vision.
Speaking on behalf of the BMA, Dr Mark Porter, BMA council chair, had the following to say:
“David Cameron promised a ‘truly seven-day NHS’ but there has been no detail to define what he means, how he plans to fund and staff it, and its impact on weekday services. Given the current funding squeeze on NHS Trusts, the only way for many hospitals to increase the number of doctors over the weekend would be to reduce the number providing care during the week.
“If the government really want to deliver more seven-day services then they need to show patients, the public and NHS staff their plan for how this will be delivered at a time of enormous financial strain on the NHS and when existing services and staff are under extreme pressure.”