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Pressure Sores

Hardly a day passes without media comment on the pressures faced by GPs and A & E departments.

If it takes 6 years to train an A & E doctor, then it follows that forward planning must always be for longer than that period. The Health and Education National  Strategic Report of 2012, which reviewed intakes at medical and dental schools, recommended a 2% reduction in medical school intakes for 2013. It also reminded us that current decisions on training levels would not fully impact a number of specialisms until 2025.  So we should be grateful that the A & E gap can be plugged more quickly.
 
If patients feel, whether or not their feeling is justified, that they cannot see a doctor when they want, then many will turn to A & E. The problem is that very many such cases do not warrant treatment in A & E. This is a primary reason why the government is pushing so hard for GPs to be "open all hours”. At a stroke (if you'll pardon the phrase) A & E pressures are relieved and patient satisfaction improves. That's the theory.

What would encourage GPs to open their surgeries more in evenings and at weekends?

Under QOF 2013/14 the Quality and Productivity domain provides some fairly substantial incentives for GP to discourage A & E admissions of patients on their lists. But QOF is in the melting pot; it is no longer the only stick the government is looking to wield.

Patient and Public Involvement (PPI) has been around for many years in different forms. It was enshrined in statute as a duty on NHS trusts, PCTs and SHAs under the Health and Social Care Act 2001. It remains popular with the present government. The public want to see their GPs at more flexible hours. There is also an economic argument for allowing patients to see their GPs outside of normal working hours.

So what should GPs do? Everyone is aware that the present government will soon become a lame duck at the next election looms and parliament is dissolved on 30 March next year. That is why all concerned are trying to find out what a future Labour administration would do. The problem is that, unlike 1997, that outcome is not certain. And the policies of a future coalition (of which parties?) are not predictable.
 
Which brings me back to my opening point. The pressures on A & E are with us now. A spare six years are not available to increase training numbers. So the inevitable conclusion is that a government of whatever political persuasion will force GPs to open for longer hours.

The answer lies partly in accepting the inevitable. The other part will await another article.