To think GP surgeries shouldn’t be closed over Easter weekend? [Title edited by MNHQ]

Well that’s private medicine, which isn’t what the NHS is about. There are private GPs available, for those who can afford it.

Another DN here and on duty all weekend. Usually palliative patients are covered by us as usual we have the support of our specialist palliative nurses and IMPACT line for specialist advice if needed. Not all of our patients are under the palliative team at present. OOH GPs and the walk-in centre are available, but both ridiculously backlogged. The Easter weekend can be incredibly frustrating when we need the input of the usual GP of the patient, as OOH can only do so much and are buckling under the pressure too. This can lead to delays and an impact on our caseloads. Some of the other community services are also restricted of a weekend and bank holidays, so we also find delays here. It’s not double time for bank holidays at my trust.

We also have been made to join the bank a good while back, which has put a stop to any type of overtime payments. This is quite naughty, as the hours we pick up extra are usually to help our own teams so it is effectively overtime. Personally I will pick up additional shifts to help the team out, as we can get so short staffed that things just build up otherwise. I work across a city centre and we don’t have permits either. I have had a number of fines that the trust are being difficult about, and they have now said essentially we have to find a pay and display or car park, then walk to patients. Sometimes we need bulky equipment, or we can’t take everything we have in our car as a just in case so this isn’t viable. The trust have refused to pay fines, and are trying to wash their hands of the parking issues we face. Sometimes there isn’t parking even within a 10 minute walk, and it still doesn’t negate the fact of potentially needing something from the car during the visit. The trust have been “negotiating” permits with the local council for years now and we are still waiting. We can claim back the cost of car parking, but we have to wait until the next pay month to get that.

Sorry I went off on a tangent there, but essentially although I don’t begrudge their time off the current system isn’t working (has it ever?). We are feeling the pressure more than ever and patients are surprised we are a 24/7 365 day service. I have found from experience that the majority of GPs I have been in touch with here are actually getting worse. Inappropriate referrals, refusing to go out to patients, not following up requests, not communicating to DNs. This is across different practices. Some GPs and other services definitely seem to be stuck in COVID as an excuse, and it is very infuriating. There is no reason for GPs to not assess a patient in person before making a referral, but all too often they speak to a patient or relative via phone, prescribe antibiotics for wounds before talking swabs and get DNs to go out for things they should be going out to first. For these reasons I don’t think GPs should be shut for the full 4 days, as health is a 24/7 service and OOHs GPs aren’t really built to provide 24 hour care for a 4 day weekend.

It is.
When I was a junior hospital doctor, if someone was admitted with a heart attack they’d be in hospital for a week, and we’d send them out with all their medication, having done all the tests during their admission.

Now they can be sent home a couple of days letter, with a letter to the GP saying please start a statin, start an ACE inhibitor, titrate their beta blocker dose up according to their BP, arrange a chest X-ray in 4 weeks, refer for an echocardiogram, consider anticoagulation if their CHADvasc score suggests it, refer them for weight management, refer them to an exercise programme, optimise their diabetes control - the list goes on.

I’m not blaming secondary care for doing this. It makes sense for more care to take place in the community. But there are only so many hours in the day and GPs to do the work.

Considering that most people don't celebrate Easter in the traditional sense, GPs should be open. They should be open and operate on weekends by rota. The idea of a health service being shut for 2 days is old fashioned and don'ts meet the needs of service users. I also think people should pay a contribution towards their GP appointments.

Mad. Frustrating. Exhausting.
Now imagine you’re being told you’re a lazy GP not seeing patients on a daily basis.

Hmhm I'm not so sure. They are paying Locum GPs handsomely including on weekends.

Gosh, I must be hallucinating the 40 phone calls I took and 20 or so patients that I saw face to face in my most recent day as a GP. I do apologise for sending one to A&E, but as I couldn't rule out an ectopic pregnancy it seemed reasonable. All the others I sorted out myself. You're talking nonsense.

Unfortunately there are too many people in this country for the NHS to support, and not enough money put into it. So each area of the NHS tries to pass work to other areas.

General Practice has taken on a phenomenal amount of work away from the hospital system. There are things GPs are responsible for now that would have been unthinkable when I started in the mid 1990s.

People used to be admitted to hospital to initiate insulin. Now many GPs can do it. That’s just one of many examples. It’s good for patients because it saves them travelling to hospital. But it comes at a price.

While your GP is doing insulin initiations, minor operations, joint injections, anticoagulation monitoring, “shared care drug” supervision, spirometry, heart failure drug titration, diabetes management, end of life care etc - they aren’t able to offer basic appointments. All these things used to be done in hospital.

They have always been closed on bank holidays I think. Urgent care centres and 111 is still available.

we had to call the out of hours doctor for my Dad on Christmas Day, he was on the end of life pathway and he needed meds to make him more comfortable. They treated him with care and dignity and we were grateful that he was able to stay at home.

Doesn't make much difference really, GP surgery just signpost to Walk in Centre or A&E
Used to be able to call in at the surgery at 8am for same day appointment but now that's hit and miss

Urgent Care and A&E are staffed in a different way.
A&E doctors and nurses work shifts. Day shifts, night shifts, early shifts, late shifts - it’s a totally different structure to General Practice. Most A&E doctors don’t work in A&E long term. It’s usually a 6 month post as part of a training programme. They’ll all have a turn at working bank holidays.

You can’t compare opening hours of GP surgeries with A&E.
If you want to draw comparisons, you’re better comparing GP surgeries with outpatient departments, which I expect you’ll find are closed for 4 days.

Not the same but I remember when my DP was very seriously ill and in hospital, they told me that Easter is a time to really worry as there is not the support from the consultants etc if anything was to happen. I remember being told this and thinking that he may pass away over the Easter break. It’s not just GP surgeries.

Those who work in urgent care or a&e don't have the choice to have bank holidays as they are an emergency service and a last resort. Imagine if a&e decided to take a long weekend as they are tired? Those people choose to work there and won't get bank holidays but get plenty of other opportunities to take long weekends.

I say this as an ex nurse who has worked in an emergency care area. We never begrudged GPs their holidays.

Enjoy your weekend, and thank you for doing what you do.

Which is exactly what I said to you that you took in ridge with and accused me of snarking - I said to you isn’t it better to support ways for all staff to have more time off? Instead of saying that GPs should be open? And you got arsey about it.

Everyone deserves a break. This is the GPs break. Hopefully the rest of the staff who do work bank holidays get that time back to use elsewhere in the year like I used to when I worked all public holidays.

You don’t have to kick down on one group to relieve the pain of another.

Yup the 111 dental emergency clinics open 9-4 over Easter, I worked today.

Because your thread is literally about GP surgeries being open on bank holidays which means that they would be forced to come into work?

I don’t see how you can’t understand that? How’s what you’re suggesting any different?

And I don’t say ‘dragged into work’, don’t change what point to fit your narrative.
And I don’t think it’s snark at all. You’ve made a hugely unreasonable suggestion and people are explaining to you that’s it’s highly unreasonable.

I am a GP - I work “part time”
According to some I am part of the problem.
my “part time” Is 36 hrs per week.
I am 59 - I would become very unwell working “ full time” - 70 plus hrs per week.
I am doing an extra shift at our local emergency centre tomorrow - to help.
I love my job but it is utterly exhausting- physically but especially emotionally.
I need my weekend off.

As others have said, General practice is not an emergency service. It is for routine issues, and most practices will provide some on the day availability (for which demand is incredibly high at the moment). There should be a GP out of hours service in all areas of England at least, to deal with any urgent issues.

There are some HUGE problems in primary care currently, most of which the population are not aware of, but are feeling the fallout from…. GPs have been dealing with a massive dumping of unfunded work from all manner of other services which are also struggling (secondary care, mental health, paramedics, district nurses etc etc). This coupled with long hospital waiting times, an increasingly aging and medically complex population, as well as practices folding all over, has put huge demands on the capacity practices can offer. There is a a lot of staff sickness to deal with. The government have been massively underfunding primary care for at least the last 10 years, resulting in many practices now not able to keep up with costs due to inflation and as mentioned by pp handing back of contracts. 1500 practices have closed in the past 5 years alone, putting further pressure on existing surgeries.

The government and NHSE have been dictating the types of staff which practices and primary care networks can employ - guess what, there is funding for all manner of people like mental health workers, pharmacy technicians, social prescribers, nurse associates but NONE for employing more GPs or practice nurses. so the number of GPs continues to fall, because the workload is increasing, expectations of what we can deliver are unrealistic and GP partners have had large real term pay cuts year on year. GPs are leaving in their droves, retiring early and many young doctors are not choosing primary care to train in.

Patients are understandably getting frustrated at the long waits for routine appointments and not understanding when all our on the day availability is gone by 8.30/9am. and it needs to change, but the blame lies solely at the government’s feet. There appears to have been a systematic destruction of primary care for years, which really makes you consider what the agenda is…