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GPs say longer hours a waste of resources



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Published Date: 17 April 2008
THE Scottish Government's commitment to making GPs open their surgeries for longer hours is facing fresh opposition from doctors who claim it is an inappropriate use of resources.
A British Medical Association (BMA) conference will next week hear that some GPs have decided to forfeit the extra cash rather than open for longer in the evenings and at weekends.

The meeting will be told that the millions of pounds being put int
o extended hours is "an inappropriate use of finite resources" which does not help the patients most in need.

Colette Maule, a GP in Lanarkshire, said her practice would not be offering extended hours, and there was limited support for the initiative.

The conference in Clydebank will also hear concerns about under-funding of the Scottish Ambulance Service and problems with the computerised cervical screening system.

Last month the BMA said a poll showed that the majority of GPs had opted for a plan put forward by the Scottish Government and health minister Nicola Sturgeon – but only because it was not as bad as an alternative option on the table. It will see GPs working an extra 30 minutes a week for every 1,000 registered patients. In return, the Scottish Government promised £9.5 million in extra funding, plus £6.5 million diverted from money already awarded to GPs.

But GPs feel that putting the money into extended hours is a waste of resources.

Dr Maule, who practises in Wishaw, said she did not feel there was huge support for extended hours in Lanarkshire – a view also shared by GPs elsewhere in Scotland.

But she said it was up to individual GPs to decide if they wanted to offer longer hours in return for the extra cash on offer.

"In my practice, we are not going to do it," she said. "We feel that we would be better concentrating our efforts on the majority of our patients who would need our care and are better cared for in normal hours. We are also an all-female practice which raises safety issues about opening in the evenings.

"We don't think it's the best use of our resources in the practice."

Dr Maule said there was no evidence that extended hours would tackle health inequalities or improve care.

"It is just an access issue and companies should be protecting the health of their staff by allowing them the time off to see a doctor."

A Scottish Government spokeswoman said details of how extended hours would work had now been agreed with the BMA. "It offers a number of advantages for GPs in Scotland including new funding and flexibilities around how extended hours will be provided," she said.

Other concerns being raised at next week's Scottish Conference of Local Medical Committees include claims that the Scottish Ambulance Service (SAS) is "struggling to meet its obligations due to chronic under-funding".

GPs will highlight fears that category A emergency calls are automatically prioritised ahead of their requests for urgent patient transfers.

Dr Brian Fitzsimons, a GP in Tain in the Highlands, said he had heard of a case where someone who had burnt their lip eating a chip was sent a category A ambulance.

"We are not saying that some calls are not emergencies, but there needs to be more common sense when prioritising ambulances," he said.

Dr Fitzsimons said there was also concern about increased single-manning of ambulances in rural areas, which was becoming a routine practice.

A spokesman for the SAS said: "Category A is an immediately life-threatening call and it is wholly appropriate that these calls should have the highest priority."

CONCERNS OVER RUSH TO CHANGE

DOCTORS have voiced their opposition to the "headlong rush" to create super-surgeries as a new report called for balanced debate on the issue.

The British Medical Association (BMA) said the clinics would result in the "commercialisation of patient care" as private firms vie for contracts to run the centres.

While the health think tank, the King's Fund, said that while the clinics could "present real opportunities" to treat people with long-term conditions like diabetes, it should not be assumed they will improve patient care.

Polyclinics are effectively super-surgeries that house family doctors alongside other services such as diagnostic testing, some surgery, physiotherapy or pharmacy.



The full article contains 724 words and appears in The Scotsman newspaper.
Page 1 of 1

  • Last Updated: 16 April 2008 10:09 PM
  • Source: The Scotsman
  • Location: Edinburgh
  • Related Topics: General practitioners
 
1

Angus Ogg,

16/04/2008 22:30:14
There is something breathtakingly arrogant about the BMA denying people who work 9-5 medical care and consultation after they have finished work.

Instead patients with the temerity to work and have a day job, either lose half a day's pay, or skip having treatment to the risk of their health.

Most doctors are decent, dedicated professionals, but there are a significant minority that need a good boot up the gluteus maximus :@)

2

Charles Linskaill,

Edinburgh 17/04/2008 01:03:27
"GPs say longer hours a waste of resources"

'YEP' It Sure is,,is it not,?

A Child with,,'Meningitis'!

A Mother that wants her Gp's Advice!

(Mothers request),, "NO ITS 6pm"

GP surgery response!,, "Well Tough",, "get on with it"

Result!!

'Dead Child'!!

'AYE' you cant do much more, only being paid £100k Pa!

"IS IT SERIOUS,,DO YOU THINK ITS MENINGITIS",?

"This is all I NEED To KNOW"

GP's Response!

Is this the hours 9-5pm Madam,?

(Nervous anxious Mother)
3

Charles Linskaill,

Edinburgh 17/04/2008 01:12:05
"GPs say longer hours a waste of resources"

'YEP' It Sure is,,is it not,?

A Child with,,'Meningitis'!

A Mother that wants her Gp's Advice!

"IS IT SERIOUS,,DO YOU THINK ITS MENINGITIS",?

"This is all I NEED To KNOW"!

GP's Response!

Is this the hours 9-5pm Madam,?

(Nervous anxious Mother), "NO ITS 6pm"!

GP surgery response!,, "Well Tough",, "get on with it"

Result!!

'Dead Child'!!

'AYE' you cant do much more, only being paid £100k Pa!

4

Charles Linskaill,

Edinburgh 17/04/2008 01:14:35
*ignore #3 dont know why it was, changed on posting.
5

Charles Linskaill,

Edinburgh 17/04/2008 01:38:33
Doctor, we are taught that a good man’s heart is not shut within itself, but is open to the hearts of others.
If I do not help it to heal, it will wither, never to bear fruit for the birds to eat. Would you have the birds go hungry?
6

Anne,

Eaglesham 17/04/2008 06:49:10
The government spin doctors are really doing a number on the medical profession, aren't they?

We won't relise what we had until we've lost it - and general practice is going to be sold to the lowest bidder.

Out of hours services which have been privatised in some health board areas are already telling their salaried GPs to cut down on the time they spend with each patient.

Fall for the government line and the same restrictions will soon apply in what once was your own general practice.If it hasn't turned into a Darzi polyclinic, that is!

7

AlastairEwen,

North America 17/04/2008 06:56:14
....and cue Charles Linskaill with more drivel about doctors. Thanks again, Charlie
8

Kate,

Zurich 17/04/2008 07:52:44
#8 Alastair Ewen, Charles Linksall has a very good point, as does Angus Ogg; it's not about longer hours, it's about practical hours, being available for patients (who are actually paying clients) when they are needed. The examples of the employee having to take time off or the mother with a child which could be suffering meningitis are bang on!
9

Stepford Nat,

17/04/2008 08:24:27
I bet they're all against the local income tax as well!

www.snp.org.an donations accepted
10

Charles Linskaill,

Edinburgh 17/04/2008 08:26:27
Alastair @#8,

"When you cease to strive to understand, then you will know without understanding."
11

Charles Linskaill,

Edinburgh 17/04/2008 08:28:12
Kate @#9,,

Goodmorning, thankyou for the remark.
12

jones, ken,

wormit 17/04/2008 09:19:23
It's not just GPs who are being asked to extend the working day, practice nurses and receptionists will also be required to keep the surgeries running. This will impact on their families too. Another problem is that hospital services are scaled down after hours (not true of A&E) and GPs do not have as good access to advice as they do in the daytime.

Neither should it be forgotten that most of the GPs providing the out of hours care also work a full day in their surgeries.

13

GrahamH,

Edinburgh 17/04/2008 09:24:35
A poor GP gets paid as much as a decent businesman and the latter recognises that hours must meet clients needs.

We need availability of 24 hour advice without having to drive miles over the city for an open clinic and we need need local surgeries to meet demands.

There must be a recognition that more hours are required in total, but these hours should be made more effective use of than the old system. Sceduling pensioners and unemployed cannot be difficult, it is only emergencies and those workers that need to see a Doctor pre 8AM or post 5.30PM that need more thought surely and a schedule to accommodate them cannot be difficult, just unpalatable to many GPs.

14

Kenny A,

17/04/2008 09:34:02
Doctors used to be there when needed, especialy in rural areas, it was a vocation. Now it is obvious they in some cases do not give a tosster, and are just lazy.

Not all of them of course but a fair few. It is a disgrace in many ways people earning these huge salaries cannot be bothered to justify them.

As for the comment regarding all female practices and associated security for out of opening hours, what a feeble driviling excuse, is it not also dodgy during normal hours.
15

Miss H,

17/04/2008 09:43:53
When you look at what they are being asked to provide it is not actually much. It would be like having late opening one night a week or opening on a Saturday afternoon. That is not unreasonable given that there are people who cannot get to their GP during normal working hours.

GPs really need to get real about this. They do not have public support and are damaging their reputation by adopting this attitude.
16

Will567,

West of Edinburgh 17/04/2008 09:45:19
The Ambulance,Fire,Police and Hospitals all operate 24/7 year round services and and always have done so why not GP's and their staff? For goodness sake, I can phone my bank,speak to an operator and make tranactions 24/7.I can go for petrol 24/7. I can go to Tesco for groceries 24/7 and the staff in these places are paid A LOT less than GP's are.The goverment slipped up badly by giving GP's big money for very little in return.I say tear up the contracts,simply tell them that they will get no more money until they provide an efficent and effective 24/7 service throughout the land.If they don't like it,then,like the rest of us,they can start browsing jobcentreplus website which is full of £5.70 an hour go nowhere jobs.
17

jones, ken,

wormit 17/04/2008 09:47:14
#15

I don't expect you know very much about what a GPs job involves. Perhaps you should try and find out before tossing insults in all directions.
18

Kenny A,

17/04/2008 09:56:27
19

Wrong, I do know a lot about it, an old GP was a very good friend of mine for over 30 years and he retired in disgust about the out of hours carryon a few years ago.
19

Miss H,

17/04/2008 10:00:34
18 Possibly you don't know much about what other people's jobs involve either. You may assume that people can just take time off to see their GP whenever they choose. Well it doesn't work like that for a lot of people. People might work shifts or they might be in a job where their contract does not allow them to take time off for doctors appointments. That means they have to take the time out of their annual leave. It is perfectly reasonable for the Government - and this is the case in England and Wales as well as in Scotland - to say that people in that position require to be catered for. They pay their taxes, they have a right to a service which meets their needs and GPs are going to have to accept that.
20

jones, ken,

wormit 17/04/2008 10:03:11
That seems an odd reason to retire. Any GP has the right to carry on looking after his patients 24/7.


21

jones, ken,

wormit 17/04/2008 10:06:55
Miss H, we're not talking about other peoples' jobs. This is about providing total medical care in every hour of the day. We simply do not pay enough in tax to deserve that level of service.
22

Miss H,

17/04/2008 10:21:38
22 Oh My God it is people like you I am afraid you are undermining the reputation of GPs.

People are not asking for medical care every hour of the day. What GPs are being asked to do is to provide a pretty limited out of hours service. A half an hour a week for every registered 1000 patients. It stands to reason that only big practices will have to open for much longer in that case and smaller pratices will not. The bigger the practice the easier it will be to work out rotas that allow extended opening without increasing the hours people work. If they can't do that maybe they should consider hiring a practice manager who knows how to do the job.
23

jones, ken,

wormit 17/04/2008 10:26:04
I guess you're one of them!
24

Xena - Warrior Princess,

17/04/2008 10:44:59
I think #17 has said it all. It is bad enough now that my surgery no longer does open surgery (which was fantastic) and you have to phone before 8.15 am to try and get an appointment for that day and you are not always successful no matter the guarantee we were given. I may not lose money but I do lose hours (flexi) attending the surgery in working hours. Surely it is not too much to ask for them to open a little later in the evening.
25

jones, ken,

wormit 17/04/2008 11:24:37
#25 The open surgery was a very good service for patients but governments of all persausions have impeded a return to that level of care. 48hr access was imposed and has to large extent damaged continuity of care. Polyclinics are now on the agenda and will almost certainly continue that damage.

The poor NHS has been a political football since it's inception and the personalised care that most people want from their GP (albeit preferences change with illness and age) is likely to move into the private sector, the same way it's gone with dentistry. Richard Branson has already seen this opening in the market.
26

Professor22,

lochgelly 17/04/2008 11:28:40
Why is it I pay a large chunk of NI but dont get any service back?

I pay privately for a dentist. I visit a doctor maybe 1/2 a year.

I would be happy to go private for everything if I could get appointments when I need it, not when some receptionist or phone monkey at NHS24 decides I need to see someone.

Oh, in the proceeds of going private, Give me back my NI contributions.....
27

Professor22,

lochgelly 17/04/2008 11:29:50
Ken....

"Miss H, we're not talking about other peoples' jobs. This is about providing total medical care in every hour of the day. We simply do not pay enough in tax to deserve that level of service."

Get the wasters off the dole and into work and then we would have plenty of tax to pay for it.
28

A Voice From Scotland,

17/04/2008 11:35:14
#1 Mr. Ogg, will you be so good as to answer the very pertinent question put to you by the Spook at #2. It is one of life's mysteries that needs to be explained. I'm sure the reason is perfectly fine but it needs an answer, to not do so could be considered as rudeness.
29

A Voice From Scotland,

17/04/2008 11:36:23
#28 Here here, jolly good whipping is what they need.
30

W U Merchant,

Aberdeen 17/04/2008 12:09:50
26

Ken Jones, good morning. Is the Taybridge Halt still open? I visied Wormit a few months ago and was surprised to see the Halt closed.
31

Alan B,

17/04/2008 12:21:46
The GP view put forward in the article tends to suggest they really do not understand patient needs as patients seem them.

The big problem for people that work is how to see a doctor for medical issues when u are at work all day. Yes for urgent issues then u will be off work, but for the more lingering issues. Not urgent but none the less should be seen by a doctor. Unless u work in a government type of job taking time off work at short notice, for a few visits to the doctor is not going to happen.

Solutions
1)Sat morning appointments
2)evening appointments. (could be one day a week used for people who find it difficult to attend during the day) It does not mean longer hrs as the surgery could just open later. 12-8 rather than 9-5.
3)enable people to register with gps near place of work. (Continuity of care is useless if u do not see ur doctor.) That means u can go out from work for an 11am appointment and be back at work for 11:30am. Not having to take a full day off.
32

jones, ken,

wormit 17/04/2008 12:38:50
31 Good morning W U Merchant. Yes the Taybridge Halt is alive and well!

33

Willie Macleod,

Wick 17/04/2008 12:49:56
#29 If you go to scotsman.com you can read and comment on most of the stories and articles of the next days paper before it comes online.The link is at the top of the page. Angus Ogg and others have been doing this for sometime. Hope that explains things.
34

W U Merchant,

Aberdeen 17/04/2008 13:38:01
33

Thank you.
35

CS,

Edinburgh 17/04/2008 14:07:35
Talking of "Inappropriate use of finite resources" This morning I took three hours off my works holiday time to attend a doctors appointment I had booked three weeks ago (this was the first appointment I could get). I turned up on time. I was keep waiting for half an hour as the doctor was seeing a Polish person who could not speak English and needed an interpreter. When I got into the doctors half an hour later I was given precisely 3 minutes of her time where she literally neither looked at me or touched me in anyway as to make any kind of medical diagnosis and treated me with complete distain. I was told to return 2 weeks later to have a range of blood tests taken by the practice nurse as she was running so far behind her schedule that she did not have the time to do it. When I got out her office I discovered that the next patient she was seeing was yet another Pole who a) was supposed to have been there over an hour earlier and could speak no English therefore needed an interpreter. So I now face having to use another 3 hours of my holiday time to get the attention I should have got today. Yes inappropriate use of finite resources indeed.
I have a suggestion for the UK Government as far as doctors and dentists are concerned. As it is the patient i.e. the UK tax payer who funds the vast majority of the exceedingly expensive education that gives doctors and dentists the ability to hold one of the few occupations left that can mean a job for life, that is remunerated, on average, at above 4 times the national UK average salary then you should be legally held to pay society back for being put in this privileged position. Students celebrate end of 'tax on learning'
36

W U Merchant,

Aberdeen 17/04/2008 14:20:51
My surgery has been operating a new system for the past year and it appears to be working well. When you phone for an appointment, the receptionist says that she will arrange for a doctor to phone you back at a certain time. When the doctor phones, he/she discusses the problem with you and decides whether you need to see a doctor. If you do, you can normally get an appointment the same day. If you don't, the doctor may decide to give you a prescription (also available for collection the same day) or advice over the phone. This system obviously saves valuable GP time as people who don't need appointments don't get appointments. The only improvement which I can suggest is the extension of this service into the early evening (perhaps to 8-00pm) as many people cannot get time off work to phone or to attend an appointment. A further improvement would be to open more pharmacies in the evening and at the weekends.
37

Miss H,

17/04/2008 14:21:36
36 sums up the problem very well. He/she has to take the time out of their annual leave. If someone has to go to the doctor on a regular basis they could end up losing half their holidays. That is just not acceptable.
38

W. Peyronie,

17/04/2008 14:29:10
I'm afraid the story in 36 seems highly unlikely. 3 weeks for the first GP appt then 2 weeks for a practice nurse appointment! If it is that bad, I suggest changing your practice.Does the problem of having to take holidays not lie with the employer rather than the NHS? Why is the NHS being expected to pick up the bill for private companies?
39

The Former Mr. Angry,

Perth 17/04/2008 14:52:46
I now pay NI and tax to a) not receive dental treatment under the NHS and b) now pay GP's at an inflated salary for a apparently grudged service if they have to work a wee bit extra to fit in with real client needs.

No doubt the idea was the NHS 24 would deal with the inconvenient out of 9-5 work leaving the GPs plenty of leisure time - time of course to spend the vast pay increase. And a hugely increased infrastructure.

Frankly I would now be happier to receive an enormous refund to pay for medical and dental insurance and then go choose the people who will provide the type of service I want rather than what suits them. There would be changes! I expect you'd then see a much increased willingness to provide patients a proper service at hours they need rather than this petulant display alleging waste of resources. It's not rocket science and other industries and services can manage this so why not shift with the times? It's easy - just do it. My prediction is that the enormous bureacracy of the NHS will fairly soon break up under its own weight and there will be a move back to privately funded medicine.
40

W. Peyronie,

17/04/2008 15:06:20
#41 I didn't realise Thatcherism was so alive and well in Scotland.If you want to follow the American system, which is on its way anyway, family doctors will expect to take home about £200,000 and the poor of society will be shafted.NHS 24 was the government's idea because GP recruitment was a big problem-who wants to work an illegal 80 hours/week these days after all? GPs pay £6,000 each to NHS 24 for opting out and the government's plan of cost cutting call centre medicine has backfired spectacularly, with it now costing 6x what it did when GPs ran it before 2004.Try blaming the governement for the NHS vandalism, rather than your local GP, who already provides an 8-6 service and probably also works for NHS 24.
41

The Former Mr. Angry,

Perth 17/04/2008 15:24:18
#42
You can call it names if you want, but GP's by their own actions are bringing about the very conditions which will lead to their full privatisation and betrayal of the founding principles of the NHS. Dentists first, now GPs.

All that's being asked for is a slight behavioural change as far as opening times are concerned - not much but significant to patients. The howls of protest from the BMA signifies the contempt with which they hold the very people their membership is supposed to care for and who pay handsomely through taxation for the privilege. As #43 points out, other national health services manage this - what's the problem?

As regards the poor and underprivileged I'm sure that some residual taxation could provide appropriate insurance or service and overall the financial burden will become less and as in dental care provision give back to those who currently pay taxes and get exactly nohing in return except for another bill.
42

W. Peyronie,

17/04/2008 15:26:34
#43 In France, GPs are only open from 8-12, then 3-6.In the UK, its 8-6.Patient satisfaction in France is also the highest in Europe. Then again, there are 3x the number of doctors per person and therefore the doctor can spend much more time with the patient.Also, its probably worth pointing out that GPs have no sick leave, no paternity pay, and pay 21.5% towards their pension. General Practice is hardly a private business. It receives £2 per patient per week and then, like other departments of the NHS, it can spend that budget to run the practice. In only one aspect is it private-GPs are generally partners and divide the profits-nowhere nere the mythical £100,000 that is banded about.A lot of people posting think the know how a GP surgery runs by what they read in the press.
43

The Former Mr. Angry,

Perth 17/04/2008 15:48:19
Wow - now holiday pay and they have to service their own pension! This is self-employment but with full backing of state resources funded by the taxpayer and at a no-lose salary level which will still leave most GPs well ahead of most senior managers, who may have multiple responsibilities in terms of personnel and resources, who will be expected to work a much longer week and have weekends and evenings disturbed. I'm afraid GPs are in fantasyland and the dream is about to expire.
44

JT,

17/04/2008 15:51:23
#39 you cant always change sugeries as they limit themselves to local adresseses only and ask for proof of address. I work at Crewe Toll, live in Gorgie and Doc is 10 mins walk from where I live, yet Im expected to take time off work and go to the surgery during th day and as I dont have a car it would take me about 45 mins to a hour to get there and after waiting for appt then get back so about 3hrs for a 10 mins appt. If I want an appt that day I have to phone at 8 and tell them its an emergency! How the hell can the doctors say its wrong to have extended hours. I have waited weeks for an appt that is easiest for me to attend, why cant they do it for £100K.
45

W. Peyronie,

17/04/2008 16:19:27
Former Mr Angry, All I was trying to explain was that GPs don't actually have all the perks usually associated with working in the public service. I actually agree with you that private insurance may play a role in primary healthcare, as occurs in most European countries, such as France(I have experience of working in both countries).However,the NHS as it is has to decide what the health priorities are in this country. I don't think having a GP sitting on his/her tod at 8pm one night a week is going to solve the access problems and this is really just for political spin.A lot of GPs already see patients up to 7 on some nights anyway and are more upset by the constant anti-GP government spin and bullying negotiating tactics. The whole thing needs a radical shake up, we need more healthcare workers and we need more healthcare options. Unfortunately, both the London and the Edinburgh governments enjoy using the NHS as a political football and rarely discuss the issues with either patients or those working in the NHS
46

Kenny A,

17/04/2008 18:23:44
21 Ken

To answer your question he could not stand the idea of the patients he had looked after for nearly 30 years landing on NHS 24, and basicaly watching them die. He also left the area. Obviously a lot more to it than that but I can give another example from the same area. I was a home a few months ago a a friend of mines wife collapsed, in previous days the doctor would have been there within 15 minutes max unless dealing with another patient. It took NHS 24 nearly 20 odd minutes to decide what to do and then another 40 minutes for an ambulance to arrive at what was a fairly serious case. Now this occured in a very rural and isolated area and I am sure the cities have different needs and also a lot more doctors available. What happened in this instance put a life at risk, caused long delays in treatment and cost a lot more to treat than otherwise it would have under the old system. Doctor does less work gets paid more. Tax payer pays through the nose and gets poorer service.

Logical I guess.
47

Angus Ogg,

17/04/2008 19:40:05
#8
Alistair Ewen, I wish you were right.

But you are DEAD wrong.

The vast majority of doctors are good and dedicate their lives to others. Unfortunately it is a sad fact that arrogance or incompetence within the medical profession gets a grip of a few and children die. Like one from our local surgery....

http://news.scotsman.com/generalpractitioners/GP-at-centre-of-asthma.2660600.jp
48

Angus Ogg,

17/04/2008 19:48:25
#28

Awfully sorry old chap.

No I am not a trainee, and yes I was polite and did in fact reply to my good friend the Spook over on the Ferry thread. Albeit in a cryptic and wee bit challenging manner. I did not wish to repeat that thread on more than one board as I understand this to be very bad net etiquette manners.

Tickety boo old fellow :@)

 

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