NHS 7 Day Working Week? Assess, Analyse, Evaluate, Act.

A lot of people I know who work in the NHS will chuckle when they hear all this talk of a move to 7 day working! Many people are already providing services 7 days a week, filling rotas that operate round the calendar as well as the clock, or putting in extra shifts (sometimes, but not always, paid) to make sure that the NHS is still there when people need it; day, night, Sunday or Wednesday.

But there are others that will grimace rather than chuckle. GP services are traditionally Monday to Friday, 8 – 6(ish). At weekends you have to go to back-up services, many of which do not have a great reputation. And of course there are very few outpatient clinics working fully over a weekend.

So if the government is going to deliver this promise, then they have some tough talking to do. And already, some GP groups are limbering up for the tussle. The GP online bulletin for example wrote recently:

GPC chairman Dr Chaand Nagpaul called on the prime minister to abandon manifesto plans for extended access across England. ‘Jettison the political pipe dreams of tomorrow’, said Dr Nagpaul, ‘and get real about how we resource, resuscitate and rebuild general practice’. The appeal was apparently ignored by government, as days later the Queen confirmed ministers would go ahead expanding access this year.

GPC executive members lined up to assure LMC leaders they would not accept an imposition of seven-day working. Dr Nagpaul told GPonline it would be foolish and counterproductive for ministers to do so, but that he’d had ‘no inkling’ of a contract imposition.

I have no idea which way this particular debate will go, nor how exactly the government will set about meeting their manifesto commitment. But I do know that CCGs will be in the firing line! They will be the ones with the extra cash and the extra demands. They will be the ones who have to navigate through some tricky waters, balancing the needs of patients, professionals and good practice.

Our experience is that big system change like this cannot be done ad hoc, and it cannot be done in isolation. To make a change in one significant area, you are inevitably going to impact elsewhere. So to bring about some change, you need whole system change. If you try and smooth down one air bubble under the wallpaper, then others will just pop up around you. No, the thing to do is change the wallpaper. Go for some flock; or re plaster the lot.

The analogy quickly breaks down, but the point is surely right. CCGs need to look at whole system change. They need to assess where they are, what the problems are, where the bottlenecks exist and where the resources need to be focused. An audit of where you are now is not an exercise in procrastination, but an essential first step.

Assess, analyse, evaluate, act. If you do that then maybe, just maybe, we can get to the 7 day working week.