An outdated and rigid family doctor service is resulting in less effective and unequal healthcare and is placing an unnecessary burden on employees and businesses, says the CBI.
Calling for a fundamental rethink of a service that has changed little since the NHS’s foundation in 1948, the business group says restricted opening hours, difficulty in booking forward appointments and the limited range of services on offer in many surgeries are resulting in millions of lost working days and affecting people's health.
Such issues are compounded in areas with fewer GP practices, many of which already suffer from economic or social problems.
In a new report, the CBI says poor existing provision should be challenged and new providers brought in where this is in patients' interests.
It says making it easier to switch GP, more flexible, patient-friendly opening, being able to register at more than one practice and greater use of walk-in centres and over-the-counter advice from pharmacists could make a huge difference as it would help break the link between where people live and their access to timely health care.
An Ipsos MORI survey commissioned for the CBI report shows almost one in three adults (31 per cent) finds it fairly or very difficult to get an appointment at a time convenient to them.
The survey also shows strong public support for allowing the public to have access to specialist GP services, a move the CBI believes would break the current location-based monopoly system.
The CBI believes that the problems many working people have in securing timely doctor's appointments could result in health issues not being tackled early which leads to longer periods away from work and greater pressure on the welfare system.
Independent research by Boots show some 3.5 million working days are lost each year because of time spent at the doctor's. This is more than four times as much as was lost last year to industrial action and cost the economy around £1bn.
The 2007 CBI/AXA Absence and Labour Turnover Survey identified medical appointments as the third main cause of workplace absence last year after illness and home and family responsibilities.
To date, government reform has largely focussed on secondary care, although 86 per cent of patient contact with the NHS is at the primary level.
The revised Department of Health contract with GPs, agreed in 2004, has resulted in record investment in primary care and many family doctors earning in excess of £100,000. But the CBI suggests this spending has not been matched by improvements to services.
It is today publishing Just what the patient ordered,a new report recommending a thorough overhaul of family doctor services, including:
- Making it easier for people to switch GP if they are unhappy with the service they are getting
- Patients being able to register at more than one practice, allowing working people to access GP services near their homes and near work
- More primary care services being made available over the counter from qualified pharmacists or in-store nurses, or in walk-in centres in train stations and elsewhere
- New providers being able to enter the market, for instance to deliver health services in areas with too few doctors and in deprived neighbourhoods
- An increase in practice-based commissioning, which enables GPs to match the services they offer with what their patients need. This could include specialist services such as diabetes or dermatology treatment or the introduction of 'polyclinics’, as proposed in Lord Darzi's review of the NHS in London
- Funding of GP practices dictated by the choices made by patients, enabling the best providers to flourish and requiring poorer providers to improve or close.
John Cridland, CBI deputy director-general, said: "Billions of pounds of taxpayers' money is being spent on a GP system which seems unable to respond to patients' needs.
"Official figures show 10 million adults in England alone cannot book an appointment with a GP more than 48 hours in advance. It's time there was real and fundamental reform with the needs of the patient coming first.
"But this is not just about the cost to the taxpayer. A healthy workforce is as important to employers as a workforce with the skills needed to compete. An employee who isn’t there because they have to wait around in a GP’s surgery is a lost order, a missed opportunity or an unanswered phone call.
“Good employers want employees to look after their health. But they don't want to pay for a health service that isn’t flexible enough to cope with the modern world.
"In the 21st century it should be possible to have a doctor close to work and close to home so that we can all get on with our lives with the minimum disruption.
"Where provision of family doctor services is not meeting people's needs, or in those areas where there are too few doctors, new providers should be brought in to help deliver what patients want."
Alex Gourlay, managing director, Boots, said: "There is a real opportunity to offer wider access and greater choice in primary care to help people lead healthier lives and make better use of public finances.
"A survey we commissioned found that one third of GPs asked said three tenths of their time is spent on problems that could be easily dealt with by pharmacists. That is why we are committed to changing the face of healthcare on the high street through our network of pharmacies.
"Our experience in Poole, where there is a satellite surgery in the Boots pharmacy, is that patients have welcomed more convenient access to their GP. Only by working together as businesses, employers and health service professionals can we deliver a first-class health service for patients."
The CBI report adds that more specialist GP services would allow many patients to get the treatment they need nearer home, rather than clogging up outpatient services in hospitals.
The Ipsos MORI research shows 95 per cent of people think it is important to be able to choose to visit a specialist GP depending on the health issue they have, with 29 per cent believing it is essential.
The CBI also recommends patients have far more information on GP services, such as what is available to them, where and when. It says patient feedback should be encouraged and patients made aware of the taxpayer-funded costs of services. This would improve attendance at appointments and give realistic expectations of the type and quality of services they should expect.