Shuffling the Deck Chairs

From the BBC

David Cameron says he wants to offer more patients the chance to visit a GP in the evening or at weekends.

Under a scheme to be piloted in nine areas of England, surgeries will be able to bid for funding to open from 8am to 8pm seven days a week. The prime minister said the £50m project would mean doctors "fit in with work and family life"...

He told the BBC: "Many hard working people find it difficult to take time off to get that GP appointment, so having these pilot schemes... is, I think, a very positive step forward.

"It also links to the problems we have seen in our accident and emergency departments because the number of people going to A&E departments is up by four million since the changes to the GP contract that Labour put in in 2004.

"What we need to do is enable the right people with the right ailments, as it were, to either go to a GP or to accident and emergency."

So, here's the multi-million dollar question: what's the problem with people going to A&E outside of hours instead of a GP?

OK, I know the answer to that is that A&E gets crowded and waiting times go up. But then, you can deal with that by simply putting more resources into A&E. After all, this plan is going to mean more GP resources, and fundamentally, you're dealing with the same skillset.

It's not like if you have 12 hours of A&E that you're going to get to see your GP. They can't work 12 hours - it's going to mean some sort of split-shift, so there's a reasonable chance you're going to see another GP, so any personal connection value of a GP isn't being added.

The other downside of 12 hour GP surgeries is that you're going to end up with a lot of GP time spent sitting around doing nothing, because even now, many GP surgeries are quiet at certain times of day. And you can't go moving GPs from a busy surgery to a non-busy surgery just for odd lulls. That means losing GP resources.

Look at it this way: if lots of small offices worked so well, why did we ditch town centre insurance brokers for vast call centres that you could fit an Star Destroyer in? Answer: because it's more efficient. Because you can make it that no-one is sat around waiting for customers. Because you can improve the use of specialists. You get some scale, like 1000 people working in a call centre and it's worthwhile employing a team of a dozen geeks just to work out how to improve the efficiency.

So, you build models to work out how many people to put on there at certain times, you computerise all the crap (like sending letters) to free up people, you stick a load of stuff on the net so people can do it themselves. All of this reduces the cost of the call centre, and as a result, the cost to customers. But you can only do all of that with scale, and having 2 GPs isn't going to do it.

That's not to say that there isn't a place for GPs - sometimes people need that personal connection. A woman suffering from post-natal depression probably needs that connection. But she's not going to want to see an anonymous GP any more than seeing someone at A&E. And I'm pretty sure that she'd find time in the day for something like that.