Daniel Barrett: Will a seven day NHS push primary care recruitment from crisis to catastrophe?

I listened with personal interest as the new conservative government re-launched its grand plan to deliver a “seven day health service.” In a little over a year I will be beginning life as a junior doctor along with thousands of others, all starting to question where our careers are heading. The answer for many of us could well be tied up inextricably with the fate of the “seven day NHS.”

Clearly, it cannot be morally right that patients admitted to a hospital in this country over a weekend may be between 7 and 16% more likely to die and so undoubtedly a properly functioning seven day NHS is an admirable aspiration that we should all support. However, unless the government can find a way to turn the NHS loving platitudes of Cameron and Hunt into cold hard cash and thousands more doctors then the seven day dream quickly begins to unravel. If Jeremy Hunt had a pound for every time he parrots “5000 doctors” throughout every interview he might be half way towards paying for them.

We all know that the NHS is facing rising demand from an ageing population and sure, meeting this demand may be achieved more efficiently by better using existing resources such as MRI scanners, GP surgeries, and operating theatres continuously, rather than investing in new facilities. But where are the extra doctors, nurses, technicians, porters, secretaries, receptionists, and cleaners coming from to run those extra two days? The government’s answer of course is flexible working for all staff, spreading an already paltry serving of jam over an ever bigger piece of toast.

Mr Hunt then points towards the government’s £8 billion “increase” in NHS funding as proof of their financial backing. However, this is the bare minimum that NHS England has said it needs merely to stand still, never mind expanding services and even this is in addition to £22 billion as yet unexplained “efficiency” savings. Can transforming a fully operational five day service into a seven day one with no extra funding or staff lead to anything other than reduced services and falling standards overall? Crucially though, even supposing extra funding is found, how do you persuade people to join a service where they can expect longer, more unsociable hours, pay freezes, increased workload and toughened strike laws? The goodwill of staff to keep the NHS running under increasing pressure is in growing danger of evaporating. The Royal College of Nursing have already sounding warnings that industrial action may be on the horizon if there is any attempt to cut unsociable hours and overtime payments.

Primary care is already in the grip of a workforce crisis, one which is set to become a whole lot worse with over a third of GPs planning to retire in the next five years and others planning to work part time or leave the profession. Far too few of us medical students are choosing to become GPs to replace those in this impending exodus and a move to seven day shift working could make this problem even worse. A significant number of those doctors that do choose general practice do so because it can be family friendly.

The Royal College of General Practitioners estimates 8000 more GPs are required to meet demand. The Conservatives have promised 5000. Given it takes ten years to train a GP the only way of meeting this promise, especially in light of promises to cut immigration, is to persuade more of us medical students to go into primary care—something which seems hard enough as it is, with many GP training posts unfilled. To be blunt, take away weekends off and it is hard to see how general practice becomes a more attractive career option for many junior doctors. Could the seven day NHS push primary care recruitment from crisis to catastrophe? The answer will depend largely on medical students.

Daniel Barrett is a fourth year medical student at Newcastle university.

Competing interests: None declared.