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GPs expected to provide 24/7 'decision support' under proposed out-of-hours revamp

GPs will have to be available 24/7 to offer ‘decision support’ in order to prevent patients from being admitted to hospital under a plan to radically reform the urgent care system published by NHS England today.

The move is proposed as part of a package of suggested measures to improve the care of patients seven days a week, including holding GP telephone consultations out-of-hours’ and a guarantee that patients can have ‘same-day access’ to GPs who are ‘integrated with their GP practice’.

The proposals are contained in a consultation on the future of urgent care, led by medical director Bruce Keogh, and published by NHS England today.

NHS chiefs said that they did not ‘necessarily’ want GPs to be on-call 24/7, but that they wanted to create a more ‘integrated’ system.

The document proposes that patients should be given ‘guaranteed same-day access to a primary care team that is integrated with their GP practice’, possibly through ‘GP telephone consultations both in and out-of-hours’.

It also proposes that GPs or out-of-hours teams should have ‘easy direct access’ to a same-day opinion from hospital specialists.

But what is likely to be one of the more controversial suggestions is to provide: ‘decision support from a patient’s own GP practice and hospital specialist nurse/team, seven days a week’.

Other suggestions to improve urgent care include having urgent care centres staffed with a ‘multi-disciplinary team with support of at least one GP or other registered medical practitioner’.

The proposals come after Pulse revealed that seven in ten GPs would not take back responsibility for out-of-hours care even if they were offered up to £20,000 per partner and had a guarantee they would not have to do the on-call shifts themselves.

The chair of the consultation process, Professor Keith Willett, NHS England’s director for acute episodes of care, told Pulse: ‘What we want to avoid is patients seeking urgent healthcare on the weekend or in the evening, and the person who is there not being able to access the medical information or advice that is critical to making the decisions, and therefore ultimately ends up in an avoidable transfer to hospital.

‘So what we’re talking about is not necessarily GPs being on 24-hour call, we’re talking about making sure the system is integrated. So that whether it is the out-of-hours GP, or whether it is the paramedic at the scene, or the GP seeing the patient at home that they can access the information they need, and that they can call on hospital specialist advice if that is all they need, rather than having to default to a transfer to hospital.’

He added: ‘Going back to the initial question of what is it like for the person who stands next to a patient with complex needs. Can they draw on advice from general practice, expert advice from the hospital, can they draw on the social services and directorate services that may contain the patient at home, with support.’

Asked whether NHS England would consider shifting more funding into general practice to support them doing more work out of hours, Professor Willett said: ‘The outcomes of the review are awaited and if that is what people think is the right thing to do then certainly all of those are possibilities.’

Following the consultation, which will be open to the public and NHS staff from 17 June to 11 August, the Urgent and Emergency Care Review will develop a national framework and associated guidance for CCGs in 2015/16.

BMA char Dr Mark Porter cautiously welcomed the review.

He said: ‘This review recognises the complex pressures on urgent care and as such is more likely to produce sustainable solutions. Spending on healthcare is squeezed, patient demand is rising and staffing levels are inadequate. The Government’s failed implementation of NHS 111 has only heaped more pressure onto an already stretched system.’

‘So far the Government’s response to this has been overly simplistic, with the blame being put squarely on individual parts of the health service.’

‘Emergency care providers are facing high levels of demand that are only going to increase in the years to come, and become more complex as the population grows and people live longer. We look forward to working with the review team to find a solution that enables NHS services to work together to provide the appropriate access to the care patients need.’

Related images

  • GP  on call 1 out of hours   Front  Neil O Connor

Readers' comments (50)

  • The Summary Care Record was shown to be an irrelelvance so what benefit will there be in direct links to practice records? It will still be the least qualified person making the vital decisions on the scene rather than traditional expert GP triage.

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  • "GPs will have to be available 24/7 to offer ‘decision support’ out-of-hours "
    "NHS chiefs said that they did not ‘necessarily’ want GPs to be on-call 24/7"
    Don't these two statements contradict each other or am I missing something?

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  • I do give my mobile numbers to all of my terminally ill patients with freedom to call me any time.
    If they have good package from GP, Matrons, and hospital staff, they rarely need anything from OOHs.
    Also if we have to take 24/7 responsibility, we need more budget, seeing patient at home need extra room with CQC- taps couch, infection control etc. I may have to be in suit and boot all the time. Also has to shave everyday :)
    Also all of the OOHs and Walking centres get millions of pounds from government, we get only few hundred thousands.
    They have to reduce their budget, and spread to local GPs.
    Most of the GPs are already providing week end services. But I don't want to see anybody with cough ,cold or diarrhea on week end. Or little discharge from post c/section wound. These things can wait.
    What if I am on holiday? What If I am watching movie in theatre with my kids, where we do get mobile coverage, but I have to keep feeling my mobile phone if it vibrates or not.
    Sometime patient go to OOH for their repeat scripts?
    Government should start educating patients as well.

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  • Greedy partners who have already collected all the QOF moolah will now jump the ship

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  • "...But I don't want to see anybody with cough ,cold or diarrhea on week end. Or little discharge from post c/section wound. These things can wait...". Sorry, you are hoping of no seeing the rule rather than the exception.

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  • Its not the money "Anonymous" that will encourage chap(esses) like me to jump ship - and quite honestly the money hasn't been that great the last 3-4 years - it's the workload that will encourage full timers like me in their 50's working 6-7 days a week to want to join the great sea of locum/salaried and become "ladyboy" GPs doing their session and going home at a reasonable time to do what ever normal peolple do like enjoy family life or have a hobby like keeping fit or reading literature. This is the excuse a lot of us have been looking for to go a few years early and stop paying in to NHS pension scheme until we want to reture properly. Folk I feel sorry for are the younger group of prospective GPs, few UK trained Drs seem to want to be GPs anymore again - I wonder why

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  • As an ex-PCT manager I'm almost glad I was made redundant (well, almost) - this system seems completely unworkable, presumably the brainchild of someone who hasn't got a clue. It's flawed, expensive and likely to cause more issues and lapses in care than the 111 rollout.

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  • Er anyone remember the good old days of taking a hx from a patient?
    I don`t quite understand this- are they asking someoone from my practice to be able to answer the phone all night and advice that yes Mr Bloggs needs to go to hospital for his crushing central chest pain. or that no, mrs bloggs can`t manage at home because social services haven`t sorted out a carer and she can`t cope?
    If it`s integrating knowledge between ooh systems/ A&E then fine and dandy- but not really sure how much difference that will make to the patient in front of you. More Gp`s, and acute care teams with better social services is where the money needs to go.

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  • So what is being proposed in a very sneaky way is that a GP from the practice has to be on standby to answer queries.If its a young infant then that's not something you can reliably do over the phone.So will you be saying "yes go ahead admit" or see the patient for yourself.You can call it whatever you want but its still OOH!

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  • This reorganisation will not keep people out of hospital or control demand.Demand will just keep increasing in our current system

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