Advanced Access – a step in the wrong direction

Peter Aird is a GP in Bridgwater, Somerset.

If the recent film ‘The Darkest Hour’ is anything to go by, Winston Churchill would have liked a ‘Drinks by the Dram’ Advent Calendar – available last December on Amazon for a shilling short of £10,000.

But then who wouldn’t want to start the day with a 60 year old Glenfarclas or a shot of Pappy Van Winkle’s 23 Year Old Family Reserve to accompany their Coco Pops? Churchill’s penchant for starting the day in the manner he intended to continue may have had us reaching for our CAGE questionnaires and dolling out the health advice but one can’t help admire the man for his leadership. He was a man willing to take a stand.

Locally, Advanced Access is up for discussion again. A year ago we extended opening hours until 8pm on two nights a week as a tentative step towards the government’s wish that GP surgeries be open 8 till 8, seven days a week. It’s not been a great success. Ours is not a commuter town and, for the most part, patients who have taken the late appointments would have preferred appointments in normal working hours. So should Advanced Access be extended?

I believe that Advanced Access is bad for us, our patients, and indeed society as a whole.

Most fundamentally I think we need to be clear that the problem with the NHS is not the failure of GPs to be open for longer. The suggestion, therefore, that such would solve the problems the NHS is facing is disingenuous. The problems are far greater than that and, I suspect, largely reflect the broken society in which we live.

Going along with Advanced Access only serves as one small further encouragement to the continued overlooking of the real issues. I believe that Advanced Access is bad for us, our patients, and indeed society as a whole.

Despite being a strong partnership, over the last year Advanced Access has fragmented the practice by making us more disconnected – we have seen less of each other and, outside of work, it has impinged negatively on our personal lives. Continuing with Advanced Access will perpetuate this still further and all the more if it’s extended as planned.

Advanced Access takes us away from what is really important to us and thus has us being paid to be less happy.

The only real benefit to us personally is a little extra money – money the NHS can ill afford to spend on dubious initiatives like Advanced Access. The world tells us that money is the route to greater happiness but if we were to ask ourselves what our intrinsic values are, what it is that is really important to us, few of us would say money.

Advanced Access takes us away from what is really important to us and thus has us being paid to be less happy. This will inevitably increase the risk of burn out, worsen GP recruitment and hasten the exodus of GPs leaving the profession early, all of which will impinge negatively on patient care.

So what of the patients? More altruistically we might say that one of our intrinsic values is the  provision of good quality care to our patients. But I don’t believe Advanced Access offers this. Locally there is little call for extended opening so seeing people late is a less good service and even to our working patients Advanced Access comes up short since it reduces still further the little leisure time workers can enjoy.

Neither is Advanced Access safe. We already work long, intense hours. Working longer will lead to errors – patients will be harmed.

Advanced Access actually forces those who do work to work longer and harder and denies them the right to take time out of work for genuine health concerns. It’s not our working patients who benefit from Advanced Access, rather it’s their employers – employers who, all too often, demand more than their pound of flesh from their staff and who far, too readily it seems, discipline them for even the most legitimate time off work due to ill health. This isn’t good.

Advanced Access demands both we and the workforce in general work longer and harder with the promise that that will make you happier due to some financial reward. It’s not true. As Lily Tomlin once said, ‘The trouble with the rat race is that, even if you win, you’re still a rat.’ And nobody on their death bed ever said ‘I wish I’d spent more time at the office’.

Neither is Advanced Access safe. We already work long, intense hours. Working longer will lead to errors – patients will be harmed. The GMC has advised that we should speak out if we are being asked to do more than we can reasonably be expected. Regardless of what we may currently feel about the GMC, we simply can’t just roll over and do more.

Advanced Access is, therefore, bad for us and our patients but it is, I think, another small nail in society’s coffin.

The problem the NHS has is that it is being asked to solve the problems of a broken society. But it can’t because society’s problems simply aren’t medical. This needs to be shouted from the roof tops if anything is going to change. Simply capitulating to the notion that ‘improved’ access to health will solve everything is to perpetuate the myth.

Of course the powers will be will try to make life difficult for us if we say this (indeed they have, for us, already) but we won’t be wrong just because they don’t like what we say. It is, after all, in their interests to make us out to be the villains since doing so lets them off the hook of really addressing the problem.

I’m no conspiracy theorist but isolating individuals and making them the problem rather than acknowledging the system itself is broken seems to be a trend. Blame Hadiza Bawa-Garba for the death of a child, blame GPs for the failure of the NHS – it’s all much the same. We need to come together and standup for what we know to be true if we’re not going to be complicit with what is making society worse.

I know it’s only a tiny little stand – hardly on a par with Churchill’s – but could we not take some professional satisfaction in coming together and making it ours?


The British Journal of General Practice and BJGP Open are bringing research to clinical practice. BJGP Life is where we add the debate and opinion to help ensure everyone benefits from that research.

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5 years ago

I agree that we are living in a broken society and that GPs cannot fix it. I also agree that individuals are being blamed for a broken system. This extends to patients as well as GPs. For those of us who have been damaged by drugs of dependence, we feel this very keenly. We accepted medical advice and took prescribed medication on trust. However, when things go wrong, we are told the adverse effects of the drugs are in fact nothing to do with the drugs, they are medically unexplained physical symptoms or even signs of mental illness. Perhaps we exaggerate, or even imagine these symptoms. After all, RCPsych claim antidepressant withdrawal symptoms last only two weeks for the vast majority of patients. Patients are dismissed or labelled with spurious diagnoses, offered referrals for counselling or to see a psychiatrist. This points the finger very much at the patient rather than the drug. No tests or investigations are offered to asses the nature of the damage. Is this perhaps deliberate? Patients feel desperate and lonely but fortunately we have social media, we have the internet, we have support groups, we can share our stories, we can mount campaigns. Without that the desperation and loneliness would be considerably worse and for some suicide seems to be the only escape. Many doctors are also patients and they can suffer the same fate as those of us without medical degrees. We are all fighting a battle here, a battle for something better. Extended opening hours might benefit some, but something far more fundamental needs to change. it isn’t just about working hours or access to appointments, it is far more serious than that.

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