The BMA fought tooth and nail against the establishment of the National Health Service and some of our members still remember that campaign. They now claim that opening three extra hours a week will lead to the end of the NHS. We at the Socialist Health Association find the logic of their position hard to follow.
A substantial minority of patients find it difficult to access primary care services. Problems about access have not been cooked up by Gordon Brown. They are not just about extended hours, although that is a real issue in places where there is widespread commuting. Plenty of practices have poor access arrangements, some because of efforts to comply with the 48-hour target. People in low paid jobs find it difficult to get time off to attend a GP.
Manchester Health Watchdog completed a survey of patients' experience of general practice last month. Most reported an excellent service, but some of the stories were terrible. Eighty per cent report that they have to ring the GP practice first thing in the morning to make an appointment. Not everybody can do this:
"I just cannot get an appointment!" reported on patient. "I hang on the phone for up to half an hour and then I have to go to work. I ring later and am told there are no appointments left and I have to ring back next day. They do not allow you to book for one or two days hence, you have to ring on the same day. It is a nightmare. Once the doctor asked to see me in a week's time. I tried for three weeks to get an appointment and then wrote to the doctor explaining why I hadn't returned to see her."
The BMA are worried about the possibility of big corporations providing a poor service for less money. Their claims would be more convincing if they were more concerned about poor standards in traditional self-employed general practice. Large corporations are not likely to offer a better service, but GPs are also undermining the traditional model of primary care. Many practices employ salaried doctors, partnerships are getting hard to come by, and some traditional practices seem happy to set up satellites and staff them with locums.
We support the idea of practice flexibility to meet the needs of people who find current opening hours difficult. The government needs to recognize that providing these services may mean more costs to primary care:
- to ensure enough cover for staff in the extremes of the day
- to ensure adequate diagnostic and backup facilities to make those extremes useful to patients.
Many GPs work very long hours. Some of them are our members. But opening the surgery for three extra hours a week is not an impossible burden. We don't like Brown's rhetoric when he says "you should be able to see your doctor when you want to". People should see the health professionals they are seeing as people - not as distant figures to be deferred to in the old model, not as servants either, but as partners. This is an issue which should be decided locally. Needs for access in Penge are not the same as needs in Penzance. Access is not just about doctors. Some people who want non-urgent appointments out of hours really need a nurse. Most people have very little information about the availability of walk-in centres and other facilities which might meet their needs.
The Socialist Health Association was founded in 1930 to campaign for a National Health Service and is affiliated to the Labour Party. It is a membership organisation with members who work in and use the NHS.