By Hugh Sullivan and Lindsey Williams

David Cameron’s Conservative Party manifesto of 2015 promised seven-day access to NHS services. And shortly after the election was won, then Health Secretary Jeremy Hunt launched a ‘New Deal for General Practice’ which promised additional funds to increase GP staffing levels and improve infrastructure in exchange for ‘better access, seven days a week, for everyone’.  Objections were raised by the British Medical Association on behalf of the medical profession, and general scepticism remains as to whether this initiative makes best use of finite NHS funds amidst so many other pressing needs (mental health? community care?).  But Theresa May continued to back the programme as Mr Hunt initially retained his post under her leadership, and by the time that his six-year stint came to an end in July, detailed negotiations were being undertaken across the country at local level by Clinical Commissioning Groups (‘CCG’s) with GPs to provide what was called ‘Extended Access’. 

The local GPs of Hastings and St Leonards formed a Federation to co-operate in meeting the extended service requirements of Hastings and Rother CCG. But what exactly these services should be, where they should be offered and who should offer them,  has involved a process of mind-numbing bureaucracy and micro-management. This CCG, led by Chief Officer Amanda Philpott, far from accepting the local Federation as natural providers, insisted on driving a competitive tender process that pitched it against one or more outside bidders that would have had no local patient knowledge or experience. Against a fast-approaching deadline  –  NHS England were insisting that the services be rolled out from the beginning of October – health administrators on all sides expended long hours of form-filling and jargon-spouting between themselves (we have seen some of the documents, believe us); they also involved inevitable diversion of clinicians’ time away from their duties of patient care.

It was only on the 20 September that the CCG were able to confirm to the Federation that they had ‘won’ the tender process and were expected to comply with a theoretical start date of 1 October  –  though it now seems that this date will be postponed to 1 November, as details of rates of pay for clinicians and guarantees of payment dates have still to be finalised. 

Furthermore it turns out that Hastings and St Leonards GPs are not actually going to provide seven-day cover in line with Mr Hunt’s vision. The CCG had conducted a three-week survey of patients in January asking when patients would like to be able to book appointments at weekends and found that 82% of respondees opted for Saturday morning. So what the Federation have agreed is to offer a finite and specific number of appointments on Saturday mornings plus earlier morning and later evening sessions during the week.

Walk-in Centre Closure
Be that as it may, on 21 September Ms Philpott attended a meeting called by MP Amber Rudd at Sussex Coast College, with Council Leader Peter Chowney also present, to debate the proposed closure of the NHS Walk-in Centre at Station Plaza and its re-location to the Conquest Hospital. Ms Philpott and other representatives of the CCG denied that the closure was financially motivated. There was a national policy, they explained,  to integrate walk-in centres with back-up services such as radiology which could only be satisfactorily provided alongside A & E. But Ms Philpott went on to suggest that the increased working hours which had just been negotiated with the GP Federation would encompass emergency and walk-in patient access, though that is not what the GPs believe they have signed up to.

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Whatever the truth of this, many members of the public attending the meeting clearly did not believe it. Their experience of local GPs is that they are already stretched. Adding more work, responsibility and false promises of unrealisable commitment are likely to put them under even more pressure.

Mr Chowney laid the blame on Tory cuts to NHS finances. But the reality is that the NHS persuades the government to find money for the things it wants most, or at least for what the government wants from it –  either way, it’s a wholly top-down centralised process.  The local CCG is, as HIP reported back in July, tens of millions of pounds in deficit and operating under ‘legal directions’ from NHS England. Meanwhile there’s money for ‘Extended Access’, including unchallenged sums on bureaucratic procedures to put it in place, because that is a flagship Tory policy. There’s also money to build the new Emergency Treatment Centre at The Conquest (or at least there had better be, because construction is progressing fast).  But there is no money to keep a walk-in centre where local people want it, because it doesn’t fit the national blueprint.

Where’s The New App?

There is further evidence of the disparity between headline-grabbing pronouncements from the Department of Health and actual implementation on the ground in the roll-out of another recent initiative: a smartphone app for patients that should enable direct online GP consultations. In a speech to the NHS Expo conference in Manchester on 6 September Mr Hunt’s successor as Health Secretary, Matt Hancock, identified Hastings as one of five trial areas in the country (the others were Liverpool, Bristol, Staffordshire and South Worcestershire) where patients would be able to download and use the app to book GP appointments, order repeat prescriptions and see their medical files held by their surgery.

Mr Hancock was quoted as saying he wants to “put the failures of the past behind us and set our sights on the NHS being the most cutting-edge system in the world for the use of technology to improve our health”.

At the Old Town surgery at Roebuck House, one of the Hastings practices where the app is to be trialled, it has already been possible (“for some years”, according to their local administrator) to order repeat prescriptions and book appointments online. The new system would go much further, enabling direct online consultations.  The practice had been told to anticipate that this system would go live almost a month ago, but there has been no further input from NHS England since then, and as of 1 October trialling of the app was still on hold.

A CORRECTION: update 31/10/2018
The above piece published in issue 112 confused two separate NHS initiatives coming into effect locally. A new NHS phone app, which enables patients to check their symptoms, book and manage appointments, order repeat prescriptions as well as view their GP medical records is being trialled by 20 patients of Hastings Old Town surgery. The Roebuck House surgery in the High Street was chosen as one of two surgeries in the South East to test the app which works on i-phones and androids, before it is launched to the rest of the country in January 2019. Patients will also be able to use it to register as an organ donor and choose whether the NHS uses their information for research and planning.

In a separate initiative, to be rolled out nationwide by early 2019, patients with non-urgent ailments will be able to consult with GPs online, by looking up their symptoms and, if a clear solution is not found, will receive a response from their GP within 48 hours. This online consultation service will be in addition to existing online services which allow patients to book and order repeat prescriptions.

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https://www.hastingsindependentpress.co.uk/wp-content/uploads/2017/05/news.jpghttps://www.hastingsindependentpress.co.uk/wp-content/uploads/2017/05/news.jpgHugh SullivanNewsconservative party,GP HOURS,Health Secretary,NHS servicesBy Hugh Sullivan and Lindsey Williams David Cameron’s Conservative Party manifesto of 2015 promised seven-day access to NHS services. And shortly after the election was won, then Health Secretary Jeremy Hunt launched a ‘New Deal for General Practice’ which promised additional funds to increase GP staffing levels and improve infrastructure in...The Hastings & St Leonards non-profit community newspaper