Views & Reviews No Holds Barred

Margaret McCartney: Jeremy Hunt should follow his own advice on emergency care

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1 (Published 05 January 2015) Cite this as: BMJ 2015;350:h1
  1. Margaret McCartney, general practitioner, Glasgow
  1. margaret{at}margaretmccartney.com

Jeremy Hunt recently told the House of Commons, “I took my own children to an A&E department at the weekend precisely because I did not want to wait until later on to take them to see a GP.

“People do not always know whether the care that they need is urgent or whether it is an emergency, and making GPs available at the weekends will relieve a lot of pressure in A&E departments.”1

Here is the news, health secretary: GPs already work out of hours. Some work on the weekend, early mornings, and evenings of the “extended hours” contract.2 And some work when surgeries are closed, usually in cooperatives.

Fifteen years ago I worked in a general practice that covered some 10 000 people. Being on call meant using a dodgy mobile phone the size of a brick, and a huge geographical area left little cushioning between safe emergency care and frightening shortfalls. Cooperatives were safer, as GPs shared phone calls and home visits.

I was not on my own, with no one knowing where I was, trying to drive and answer the phone to add more house calls to the list—but rather in an organised group, sharing work and pooling telephone calls. The workload changed. People no longer phoned at 11 pm with a perceived emergency, but for help with head lice or to replace a lost sick note.

Triage became necessary. Then the 2004 “new contract” meant that GP principals no longer had to work out of hours. Some grassroots cooperatives were taken over by private companies,3 sometimes with poor results.4 Patients are being given political promises of better access,5 but GPs are barely keeping afloat with current workloads.6

The political solution to urgent and emergency care has been to complicate it: citizens are left to decide between minor injury units, walk-in centres, pharmacies, hospital emergency departments, or the GP.7 The 111 phone number was introduced to help “the NHS deal with growing demand by directing people to the most appropriate place for their injury or illness,” Hunt said, but he seems not to have taken his own advice.8

The NHS works because it “meets the needs of everyone.”9 Needs are not wants. If Hunt had thought that his children needed assessment in an emergency department I would have been sympathetic. But to turn up simply for convenience is contrary to the “fair use” principle of the NHS.

We need to prioritise continuity of care before access10 and get rid of the tick box time wasting of the GP contract, which has raised demand for appointments and taken them away from the people who actually need them. The last thing we need is politicians circumventing the system.

Notes

Cite this as: BMJ 2015;350:h1

Footnotes

  • Competing interests: I have read and understood the BMJ policy on declaration of interests and declare the following interests: I’m an NHS GP partner, with income partly dependent on Quality and Outcomes Framework points. I’m a part time undergraduate tutor at the University of Glasgow. I’ve written a book and earned from broadcast and written freelance journalism. I’m an unpaid patron of Healthwatch. I make a monthly donation to Keep Our NHS Public. I’m a member of Medact. I’m occasionally paid for time, travel, and accommodation to give talks or have locum fees paid to allow me to give talks but never for any drug or public relations company. I was elected to the national council of the Royal College of General Practitioners in 2013.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

References

View Abstract