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Independents' Day

GPs to co-ordinate 24/7 care for the elderly from next year

The GP contract will change to include a responsibility for practices to provide a ‘named GP’ responsible for co-ordinating all the out-of-hospital care for vulnerable older people from next year, the health secretary has announced today.

Jeremy Hunt said that he would seek changes to the GP contract to establish a 24/7 service that ‘pro-actively’ looks out for patients, with the vulnerable elderly the first to be included in 2014.

Mr Hunt said that ‘fundamental change’ was needed to reduce the pressure on A&E departments and would mean more joined-up care, with GPs overseeing primary care, social care and A&E use for all the vulnerable elderly patients on their lists.

Today’s announcement said: ‘Fundamental changes mean joined-up care - spanning GPs, social care, and A&E departments - overseen by a named GP.  Many vulnerable older people end up in A&E simply because they cannot get the care and support they need anywhere else.’

‘These changes will reduce the need for repeated trips to A&E, and speed up diagnosis, treatment and discharge home again, when patients do need to go to hospital.’

The proposals, which are currently being put together, follow their inclusion on NHS England’s review of primary care launched earlier this month.

Mr Hunt said they would include:

  • Patients having a named clinician responsible for the coordination of their care right across the NHS – between hospital, in care homes, and in their own homes. This is subject to on-going engagement, but current views are that a GP should fill this role.
  • Care for older people must be joined up between social care services and the NHS, starting with the £3.8 billion integrated care fund recently announced by the Chancellor.
  • Information and patient records must be shared across the NHS and social care services so that accurate clinical information is available at all times to everyone involved in a patient’s care, and staff can spend more time providing care, not form-filling.  By the end of 2014 at least one-third of A&Es should be able to see the GP records of their patients; and at least one-third of NHS 111 services to be able to see the GP records of their callers.

Mr Hunt said: ‘This winter is going to be tough– that’s why the Government is acting now to make sure patients receive a great, safe service, even with the added pressures the cold weather brings. But this is a serious, long-term problem, which needs fundamental changes to equip our A&Es for the future.

‘In the long term, I want a 24/7 service which recognises patients as individuals and looks out for them proactively.  Starting with our most vulnerable, this Government is going to support the NHS in doing exactly that.’

The DH further outlined how £250m of the £500m extra cash that the DH has promised to tackle the A&E crisis will be used with primary care set to benefit from an additional £25m for district nursing.

GPC chair Dr Chaand Nagpaul said that GPs needed increased time and space to deliver ‘high quality care’ to older people and reduce A&E admissions.

He said: ‘GPs already deliver vital services to older people and manage their care in the community. This involvement makes GPs ideally placed to play a key role in helping to address the challenges that the NHS is facing from an ageing society.

‘Ministers have already acknowledged that GPs are working harder than ever before, but the government must also realise that GP services are stretched to breaking point.

‘GPs need increased time, space and capacity to care for vulnerable older patients. It is only through real investment, support and partnership with healthcare professionals that the NHS will be able to deliver the personalised, high quality care for older people that we all want to see.’

Dr Michael Dixon, chair of NHS Alliance, said he was ‘entirely supportive’ of the plan to introduce a named doctor, but that GPs would need more resources.

He said: ‘If we are going to deliver this new, patient focused agenda we will need to reinvigorate primary care.  There will have to be greater resource in general practice, with, as Mr Hunt has acknowledged, at least 50% of doctors becoming GPs, and we will need to prioritise what’s important, ensuring that we stop doing the unnecessary tasks such as QOF “tick-boxing”, and instead really focus on whole person care.’ 



Readers' comments (46)

  • I am bemused. This is exactly what we do already in our Practice and most good practices across the country. Our patinets know their dr and rarely need to be seen in A&E, they are visited when they are in hopsital by us, we speak with the hospital drs to ensure no failed discharges. Cannot understand why the secretary for health cannot see that the large majority of practices already look after their patients exteremely well

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  • Harry Longman

    This puts the GP-patient relationship back at the heart of primary care. Masses of evidence points to the value of continuity, and the policy declares support for this. We must be wary however of additional bureaucracy and burdens, or arbitrary definitions of "frail" and "elderly". Continuity can be important at any age, and the system needs to support what is clinically appropriate for all patients.

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  • Glib words from a man of straw.

    Nothing new to see here.

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  • Initially looks just like electioneering but is actually very sly. A poisoned chalice for those GPs who have chosen to remain in England. You have my sympathies.

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  • So, how many sessions/week is he expecting me to give up in order to provide this model of care?

    I already work 11-13hours/day and several more on the weekend. I am not going to add more work on top as I'll burnout quicker then a match stick at this rate.

    But if I reduce my clinical time, how will my patients see me to ensure continuity of the care is maintained?

    Please get your head out of the sand "GP to do everything" IS NOT THE ANSWER TO ALL THE HEALTH PROBLEM IN THE COUNTRY.

    But of course, Mr Hunt isn't interested in good health care, he is interested in finding a political scapegoat which he can sacrify for the benefit of his government

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  • This is a marvellous idea and easily achievable with a tripling of resouces .

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  • This looks amazing if they double or triple NHS budget. Throwing £500million as a one off at A&E was joke to begin with. Now Mr. Hunt expects me to do all the work during the day and night and not make mistakes and be extra special to all my patients to get brownie points. Is this for real?????

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  • I missed the part of the speech where he said how much extra per patient each co-ordinator was being remunerated for their extra time and responsibility.

    I did see that hospitals are being given 500M, district nurses 25M and GP surgeries .... no I missed that as well.

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  • Excellent idea Mr Hunt!
    All we need to do now is to ban GP leave and install pull out beds so we can stay where we are needed.
    Anyone who sneaks off can have their names published in the local press!
    Name an' shame 'em says I.Jolly good, tally ho - join the Berkshire Hunt today. .

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  • could Peter Holden et al, do a proper press release that the press will listen to, and won`t alienate the public back to this.

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  • Hilarious

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  • I'm 58 and can take a full pention age 60.
    I will be stopping contributions anyway in April 2014.

    If this comes to pass I and may hundreds/1000s of GPs in their mid 50s WILL resign.

    Is that the real plan!

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  • sorry should read

    If this comes to pass, I and many hundreds/1000s of GPs in their mid 50s WILL resign.

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  • Anyone know how I can set up a private practice like that nice Dr in one of the papers?
    I dream of seeing 1 pt for 30mins and only seeing 20 people a day .
    I can`t cope with this political twoddle for much longer
    Seriously, anyone?

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  • This is a great idea but I think it is more PR puff, I cannot see where the GP's time is going to come from. What happened to the idea of community based geriatricians to oversee this care, the BGS has been bouncing this idea around for years but getting no-where with it.

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  • Deafening silence from the BMA and Royal College of course

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  • This is a negotiation tactic. Looks at the sighs of relief when we 'win' and accept a a 25% pay cut, more extended hours and celebrate the defeat of this proposal.

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  • Don't care!

    VER taken in the spring, living abroad and wondering why anybody would want to work in UK Genetal Practice.

    Pay off debts downsize and retire early.

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  • Politicians formula for running NHS:

    1. At all costs maintain the illusion that voters can have infinite amounts of instantly accessible high-quality healthcare , day or night, with a doctor of their choice, maintaining excellent continuity throughout -- whilst paying nothing. Then you will get reelected.

    2. Maintain successful tactics used for past decade of blaming GPs for any failure that applies at any point in the above statement eg accessibility, quality, continuity, lack of choice, unaffordability. Too expensive? Due to greedy GPs being overpaid. Lack of accessibility? Due to GPs not working hard enough. Lack of continuity? Due to greedy GPs lacking sense of vocation a. nd giving up their duty of OOH care.

    3. Repeat the assertions of step one and two often enough to your friends in the press, which conveniently ignores the other side of the story that should be promulgated by doctors' leadership (in any case very weak) and public will believe everything you say.

    4. Every year, no matter what the problem in the NHS, use the above tactics to suggest that it is all the GPs fault then put the additional duties to solve the perceived problem in the GPs contract. At the same time, in order to save money for other parts of the NHS that are so busy ag AE , cut yet more funding out of primary care so that its' proportion of the overall NHS budget continually falls (ignore all the facts to the contrary such as recruitment difficulties in general practice and the rise in consultation rate in general practice vis-a-vis the static consultation rate in accident and emergency).

    5. Whenever reelected -- return to step one.

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  • I thought the Minister for Health was "responsible for co-ordinating all the" NHS "out-of-hospital care for vulnerable older people" - why's that then going to be named GPs from next year, are we going to a ministerial salary to match?

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