Professor Steve Field has recently been appointed as the first chief inspector of primary care for the United Kingdom’s National Health Services (NHS). His first order of business is to fix the current problem with general practitioners (GP). Field claims that general practice surgeries “that offer inadequate care and do not open for long enough, or pose a safety risk to patients, are at risk of being closed down under a beefed-up inspection regime planned by the profession’s new policeman, who also wants local doctors to offer seven-day services.”

Field has numerously stated that he would not shy away from using sanctions, including fines and suspensions of surgeries’ licenses, to drive through major improvements to poorly performing GP practices. In a recent interview he stated, “I will not hesitate at all to order the closure of GP practices that we find to be unsafe, or providing poor access, or which do not care for patients properly or treat them with dignity.”

The UK has been known to have great general practice, but that is being overshadowed by a small percentage of practices which aren’t providing appropriate access or quality of care. Field said that “10% of the 7,607 general practices in England need to make major improvements.” A practice has already been shut down in Essex because the premises put patients at risk and were denying patients their privacy, dignity and confidentiality because the consulting rooms had no doors and conversations with the GPs were easily audible to others.

A huge initiative that Field wants to implement is seven-day availability for people to have access to general practices. He wants patients to be able to get advice and consultation on weekends. It would not have to be their family doctor, but as an alternative, could be any general practice from a newly formed federation of nearby surgeries “which would take it in turn to see patients on Saturdays and Sundays, in order to make the extra workload bearable” for general practices. Smaller general practices have already began to offer seven-day access, as well as making appointments available earlier in the morning and later in the evening. This is a result of the cash incentives from the NHS clinical commissioning groups and NHS of England. Field said that “this should be the norm.”

Although this plan seems to have great benefits, there are some critics of it. Dr. Clare Gerada of the Royal College of General Practitioners has called Field’s plan “unrealistic.” She claims that “I would love there to be seven-day a week access to GPs. But that’s not possible when we need 10,000 more GPs to cope with our growing workload, and when GPs are getting their smallest share of the NHS budget for a decade. She also claimed that people in power have to stop pointing fingers at the general practitioners for all of the problems.

Fields has said that his first act as chief inspector will be to crackdown on England’s 48 providers of out-of-hours NHS care, following scandals that have seen several patients die and serious concerns rose about the quality of care provided by private firms. Some other major concerns of Fields include GP’s lack of access to patient’s medical records, the poor quality of people working overnight and weekend shifts, doctor’s unfamiliarity with patients, and medication errors.

Lastly, Field states that there is a huge nexus between quality of patient care and after-hours consultation. “The link between the patient and their GP and GP practice is much weaker than in office hours. That’s one of the reasons why there’s a greater risk of poorer outcomes in out-of-hours and a key reason why my new inspections will start with these services.”

Do you think Field’s plan is a step in the right direction for UK general practitioners? Or are the critics correct in saying that it isn’t obtainable? If so, what other sort of initiatives should he be concerned with that are more obtainable then his current plan?

 

Sources: The Guardian

Picture: Medacks.com