Jeremy Hunt accused of compromising weekday hospital care

The health secretary, Jeremy Hunt, has been accused of compromising the care patients receive during the week by not taking forward his pledge to hire more junior doctors to help deliver a seven-day NHS.

The Liberal Democrats’ health spokesman, Norman Lamb, said that with juniors now having to work more at weekends, already under-staffed hospitals had fewer medics on duty on weekdays.

He said Hunt had done little to make good on the hiring pledge he made in parliament during the year-long dispute over junior doctors’ contracts.

“My fear is that unless you can guarantee that there will be more junior doctors employed, imposing a change which involves more hours being worked at weekends will inevitably reduce the numbers of hours worked during weekdays when the pressure is at its greatest,” Lamb said. “This could result in real safety concerns.”

In a letter to Lamb, Hunt failed to provide any detail of how many more junior medics would be trained and employed this year or any other year before the end of this parliament in 2020.

He has previously acknowledged the potential for too few doctors being on duty between Monday and Friday as a result of the new contract he imposed in October on all 54,000 junior doctors working in the NHS in England.

Hunt told Lamb that it was up to hospital trusts to expand their junior doctor workforce, raising doubt that his previous assurance would be acted on.

Nor did the letter provide any detail on how many extra trainee medics would join the NHS this year, despite Hunt having told Lamb in the House of Commons on 5 September that he would give him a number.

“This letter from Jeremy Hunt fails to reassure me,” Lamb said. “There appears to be no clear plan as to when more junior doctors will be employed and yet the changes are being imposed immediately.

“There seems to have been no assessment of the number of additional junior doctors needed to ensure that additional weekend hours won’t have a dangerous effect on weekday cover. Jeremy Hunt has failed to provide the evidence to back up his claim that the problem will be addressed by additional junior doctors.”

When Lamb first raised the prospect of shortfalls in weekday medical rotas affecting care standards in a Commons debate on the dispute on 19 May last year, Hunt told him: “The short answer is that we need to increase the NHS workforce.”

Hunt’s letter, however, simply restated the government’s longstanding pledge that there would be 11,500 more doctors by 2020 than there were in 2015.

Dr Nadia Masood, a member of the Justice For Health campaign group and the British Medical Association’s junior doctors committee, said she shared Lamb’s concerns about weekday care.

“Weekday care is already suffering. The NHS is struggling every day of the week. So yes, if we are going to remove more doctors from weekday shifts to staff the weekends, weekday care will deteriorate. We need more doctors every day of the week, not just weekends,” she said.

Masood said she had never believed Hunt’s pledge to recruit more junior doctors, “because he and the government have repeatedly shown themselves to be deceitful with NHS-related issues to further their own political agenda, for example [their claims about] £10bn extra funding to the NHS.”

She said ministers and Health Education England, the medical training and education agency, “have no idea how many doctors we actually need. They are making it up as they go along, which is a staggeringly incompetent way to handle something as valuable as our National Health Service”.

In his letter to Lamb, Hunt said: “Health Education England does not expect significant change in the overall numbers of training posts and trainees, but it cannot say how many there will be at any point in time.

“The number of non-consultant non-training medical staff employed is for providers [NHS trusts] to determine based on the workforce required to deliver services … It is therefore difficult to provide the expected total number of junior doctors by grade.”

The Department of Health said: “The new junior doctors contract is making it easier for hospitals to roster doctors at weekends as well as improving patient safety right across the week. Working with Health Education England, we will ensure that the NHS has a further 11,000 doctors by 2020 – as well as increasing the number of medical training places by 1,500 in a year’s time.”

Jeremy Hunt accused of compromising weekday hospital care

Seven-day NHS plan puts weekday surgeries at risk, warns top GP

Britain’s top GP has said surgeries will have to stop seeing patients during the week unless ministers abandon their drive to guarantee access to family doctors at weekends.

Dr Helen Stokes-Lampard condemned the policy, a key Conservative pledge, as unrealistic and said it was ignoring the lack of demand among patients to see GPs at weekends and a serious shortage of family doctors.

The government has promised to ensure that people in every part of England will be able to see a GP from 8am to 8pm every day of the week by 2020 as a key element of its push to create a “truly seven-day NHS” by the end of the current parliament.

“It’s unrealistic in the current climate. We haven’t got the people, we haven’t got the resources. If you give people access on a Sunday afternoon they’re not going to have access on a Tuesday morning. They can’t have it all”, the chair of the Royal College of GPs said in an interview.

Calling for surgeries weekend opening to be restricted to Saturday mornings, Stokes-Lampard said: “We should be responding to what is needed in an area, and balance that realistically by what can be provided safely. Because quite frankly if you open on a Sunday afternoon but you’re closed on a Tuesday morning, who’s going to benefit?.

There is so little demand from patients to see a GP on Sundays that plans to compel at least one surgery in each area to open on that day by 2020 should be dropped, she said. Nor do many people want to attend a surgery on a Saturday afternoon, she added.

David Cameron pledged access to GPs from 8am to 8pm seven days a week at the Conservative party conference in 2014, and established a £50m “challenge fund” to deliver it. Some surgeries that have begun opening at weekends, however, have scrapped their experiment because of the small numbers of patients seeking appointments on Saturdays and Sundays.

The chair of the Royal College of GPs, Dr Helen Stokes-Lampard. Photograph: Andy Hall for the Observer

A relentless rise in the need for care is prompting more GPs to retire early or move abroad, leaving the profession facing a growing workforce crisis and patients facing long waits for appointments, Stokes-Lampard said. As a result “we’re layered too thin at the moment, we’re spread too thin. We can’t sustain a good five-day service at the moment, a seven-day service is unrealistic. If we can’t provide eight to six Monday to Friday because we’re stretched to breaking point, we’re certainly not going to be able to provide seven days a week.”

She said general practice was “closer to the edge than it has ever been in living memory”, and cast serious doubt on ministers being able to fulfil another key NHS pledge – to increase the number of GPs in England by 5,000 by 2020 compared with 2015. It will be very hard to deliver that number without many GPs coming from overseas or former doctors being persuaded back into work, she said.

The Liberal Democrat MP Norman Lamb, who was a coalition health minister until May 2015, denounced the pledge of access to GPs all day and every day as a “superficially attractive gimmick”.

“This target is driven by seductive headlines, not sound policy. It will distort priorities and resources away from action which could make a real difference to people’s lives, such as ensuring that people have both their physical and mental health needs effectively met in primary care,” he said.

“No one believes that there will be sufficient resources to deliver this plan. The risk is that it will leave dangerous gaps in provision during the week.

“Pursuing superficially attractive gimmicks like this amounts to a smokescreen for the dire threat the NHS and care system now faces as it is starved of the resources it needs to provide effective, prompt and safe care.”

The shadow health secretary, Jonathan Ashworth, said: “These serious doubts about a flagship government pledge will raise widespread concerns. It’s yet another warning about the scale of the underfunding and understaffing now impacting our NHS.

“In her six months as prime minister Theresa May has shown no regard for the state of the NHS, so it’s no surprise it now looks like her own manifesto commitments will be broken.

“But in 2017 the government simply must not carry on ignoring the warnings. Instead they need to come forward with a genuine plan to give the NHS and social care the resources they need to deliver the very best care every patient deserves.”

The Department of Health insisted the government would achieve its ambition of seven-day opening, and that the policy was popular. “This is a common sense reform with wide public support, and one we will deliver”, a spokeswoman said.

“People don’t just get ill Monday to Friday, nine to five, and 18 million patients now have weekend and extended access to a GP, which has already shown evidence of relieving pressure on other parts of the NHS.

“To deliver our pledge, we are putting an extra £2.4bn into GP services, which will help expand the workforce.”

Seven-day NHS plan puts weekday surgeries at risk, warns top GP