Improve services or lose out to private sector, government warns GPs
pharmafile | August 21, 2007 | News story | |Â Â Â
The Department of Health has sent out a strongly-worded warning to England's GPs, telling them they must open in evenings and at weekends, or face losing out to private companies.
The letter from Mark Britnell, Director of Commissioning at the Department of Health, is understood to tell PCTs and general practitioners that 'tangible improvements' must be seen by the end of 2007.
In public, the government has claimed that a recent survey proved that most patients are satisfied with their access to services, but the letter leaked to the media shows the issue is an urgent priority for ministers.
PCTs have the power to award primary care contracts in their area to new private providers, but few have responded to government encouragement so far.
Primary care trusts' commissioners are coming under renewed pressure from the government following the re-igniting of controversy around out-of-hours care.
A recent report by a parliamentary committee showed that out-of-hours services are in disarray in many parts of the country, with some areas worse off than before the general practice reforms of 2004, which allowed GPs to opt-out of after-hours care.
Unsurprisingly, GP leaders have hit back at the letter, which they say shows the government taking a bullying approach.
Citing again the recent GP Patient Survey, which suggested that 84 in every 100 patients are satisfied with access to their local practice, with only 7% wanting weekend opening, Dr Laurence Buckman, a north London GP and chairman of the BMA's GPs' Committee, said the government demands were unreasonable
"It seems inappropriate to me to use this aggressive stance in ordering primary care trusts to take action," said Dr Buckman.
"It is also most unfortunate that the government has decided to threaten the NHS managers whom it expects to make changes to GPs' services."
Doctors say they are aggrieved with the new threats, particularly as the existing out-of-hours system was agreed after apparently hard-fought negotiations in 2004. Many observers, including the Public Accounts Committee in its recent report, say the government badly misjudged the effect of the reforms, which left a vacuum in after-hours care and little incentive for GPs to offer extended opening.
The BMA says there are numerous barriers to extending opening hours, including diverting limited resources out of daytime hours when patients want to be seen.
"Offering GP services involves more than a doctor sitting in a consulting room – general practice in the 21st century requires an extended primary care team backed up by the diagnostic tests not usually available at evenings and weekends. If the government wants to talk to us, we'll listen, but we don't want to see them force practices to reduce the quality of care they can prove they provide to their patients," added Buckman.
The government says primary care services can be extended without diverting resources from core services, but this does require new ways of working and service re-design.
An early draft of the letter from the Department of Health's Mark Britnell is understood to have made it clear the government would back PCTs which sought to appoint private providers where GPs were judged to be underperforming. But this threat is merely implied in the final version of the letter, indicating the fine line the department is trying to walk – seeking to spur PCTs into action, but not creating ill-will over further enforced reform.
