If David Cameron wants seven-day GP clinics, he’ll need market reform

News & Analysis

30th September 2014

Today, David Cameron will pledge that if he’s re-elected he’ll give everyone access to a family doctor seven days a week. He will say:-

“People need to be able to see their GP at a time that suits them and their family. That’s why we will make sure everyone can see a GP seven days a week by 2020. We will also support thousands more GP practices to stay open longer, giving millions of patients better access to their doctor. This is only possible because we’ve taken difficult decisions to reduce inefficient and ineffective spending elsewhere as part of our long-term economic plan. You can’t fund the NHS if you don’t have a healthy, growing economy. This will help secure a better future for Britain — where people can be confident that when they or their loved ones need it, our NHS will be there for them.”

Now, I’m all for this. I was all for it when the Tories announced it in the 2010 manifesto, and can’t quite work out why it’s now being promised for 2020. Why the wait? As health reformers from all parties have found out over the years, the GPs really do hold the whip hand. “Cameron tells GPs to work at weekends” runs The Times’ headline. But under the NHS system you can’t tell GPs to do a thing – unless you stuff their mouths with gold, bribing them with new contracts. Doctors unions are already complaining, and hinting that they won’t play ball. What Cameron should do is promote full competition for GPs surgeries, allowing any qualified doctor to set up a clinic, everywhere, and abolish current restrictions. If doctors want to compete for patients by taking appointments on a Saturday, then so be it. This is happening already in the paid-for healthcare market. Take the Poles who grow exasperated with the NHS and are prepared to fork out for a budget GP appointment. Here’s an Economist report on the My Medyk clinics from June 2013:-

They reflect the famous Polish immigrant penchant for hard work. Krzysztof Zemlik, business development manager at the Green Surgery in central Manchester, which admits patients until 9pm or 10pm seven days a week, says that his surgery sometimes stays open until two or three o’clock in the morning. The My Medyk clinic successfully lobbied to be allowed to open on Sundays (it pointed out that taxi firms are able to do so).

In healthcare, as in so many other places, the market is the best mechanism to have public services respond to public demand.