In Sweden a public referendum was held to decide how best to support the Swedish healthcare system which whilst modelled on the NHS, was effectively being bankrupted by public demand (ring any bells?) The choice was: to pay an annual stipend per capita to support health care being free at point of contact or to opt for payment at point of contact for everything outside genuine emergency assessement and treatment. The public voted for the latter, and today have a health system which is efficient, effective and capable of manageing public demand because the public have been educated in the fiscal difference between clinical need and public demand!! Which I may suggest is exactly what needs to happen in the UK
Which is exactly what East of England Ambulance Trust have done! We have successfully merged 111/OOH/999 services together by tweeking the various systems to ensure compatability. We also talk to each other and have the same common goal, it is my sincere opinion that this integrated model is the only way unscheduled care can succeed. However; GP's will still need to re-engage with OOH care, which is difficult to forsee given the sheer demand being placed upon them in day-time surgery work. Patient safety dictates that OOH in particular is a GP led service. That said the DoH needs to recognise that one of the key issues dominating unscheduled care provision is Patient Demand Vs Patient Clinical Need.