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Hunt blames GPs for a rise in patients presenting at A&E

Health secretary Jeremy Hunt has blamed GPs for rising A&E attendances, saying that ‘poor primary care provision’ is the reason for increased pressure on emergency services.

Mr Hunt said four million additional people were going to A&E because of the ‘disastrous’ GP contract negotiated by the previous Government that removed responsibility from the profession for out-of-hours services.

In comments the GPC said were ‘nonsense’, Mr Hunt told MPs today that ‘poor primary care alternatives’ which were the result of the changes to the GP contract were contributing to the ‘huge pressure’ on the emergency services.

A Department of Health spokesperson later insisted that Mr Hunt was ‘clearly not blaming GPs themselves’ and was instead blaming the GP contract for GPs’ ‘working practices that could be much better suited to modern demands’.

Earlier this month, the Labour Party published figures that showed the NHS had missed the national four-hour A&E wait target every week for six months.

In response to a question in the House of Commons about rising pressure on A&E departments, Mr Hunt said: ‘’The reason that there is so much pressure on A&E is because of the disastrous GP contract that was negotiated by her Government, since when an additional four million people every year are going to our A&Es.’

‘That is what is causing the huge pressure. That is what we are determined to put right.’

Responding to another question, Mr Hunt added: ‘We are looking at the root causes of the fact that admissions to A&E are going up so fast - namely, that there is such poor primary care provision; that, as we discussed earlier, changes to the GP contract led to a big decline in the availability of out-of-hour services; and, that health and social care services are so badly joined up.

‘That is how we are going to tackle this issue with A&E, and that is what we are doing.’

But GPC chair Dr Laurence Buckman said the health secretary’s comments revealed an ‘impressively superficial analysis based on no evidence’.

He said: ‘It is the sort of analysis you expect from people who don’t know much about the health service. GP services are available around the clock. They have been before and since 2004 and it is, as I said, a superficial and unwise analysis to say that one is the corollary of the other, as they are not related in any way.’

‘Most GPs were not providing personal access out of hours anyway, it was provided through a variety of out-of-hours routes and that has been the case for the past 30 years, so it would be nonsense to suggest that because GPs haven’t been personally responsible since 2004, therefore casualty is full of people. That is just such fatuous nonsense I question the wisdom of the people briefing the Secretary of State.’

‘It is always useful to point the finger at someone else when actually you are to blame for what has happened, and he and his Government have imposed a contract which is going to significantly reduce access for patients and maybe he should reflect on that.’

A DH spokesperson later said: ‘Jeremy Hunt was clearly not blaming GPs themselves. He was blaming the GP contract which ties GPs to working practices that could be much better suited to modern demands - especially an aging population with more complex needs.’ 

The exchange came after Mr Hunt had also been fielding questions from MPs over the troubled rollout of the new urgent care number 111, which was branded by Labour MP Diane Abbott as ‘a trademark Government shambles’ after she highlighted the leaked report that was obtained by Pulse last week showing evidence of delays, dropped calls and an 11-hour wait for a call-back.

 

Jeremy Hunt on the pressure on A&E

Andy Burnham (Leigh) (Lab):
Accident and emergency departments across England are being closed, even though all are under intense pressure. For 11 weeks running, the NHS has missed the Government’s national A and E target. Last week, in places, one in three patients waited more than four hours in scenes not seen since the bad old days of the mid-1990s. What clearer symbol of the growing crisis in A and E is there than a tent as a makeshift ward in the car park at Norwich? The Secretary of State’s failure to address that cannot continue. Nursing jobs have been lost, ambulances are queuing outside A and E and patients are being treated in car parks. When will he get a grip?

Mr Hunt:
The statistic that the right hon. Gentleman will not give the House is that for the year as a whole, which ended last March, the Government hit our A and E target. Furthermore, he still will not tell the House about the disaster that is happening in Labour-controlled Wales, where the A and E target has not been hit since 2009. He still refuses to condemn what is happening there. There is a lot of pressure on A and E, because 1 million more people are using A and E every year, compared with just two years ago. What are the root causes? They are poor primary care alternatives that date directly to the disastrous GP contract negotiated by his Government, since when more than 4 million additional people have been using A and E every year, social care and hospital sectors that are not joined up — Labour had 13 years to sort that out but did nothing — and problems in recruitment that have been made a great deal worse by his disastrous decision to implement the working time directive. It is time he sorted out his own issues before trying to criticise the Government for sorting them out.

Meg Munn (Sheffield, Heeley) (Lab/Co-op):
Under the previous Government, my constituents could get an appointment with their GP within 48 hours. I recently heard of a wait for a routine appointment taking three weeks. Is not this one of the reasons there is such pressure on A and Es, and will the Secretary of State reintroduce the 48-hour appointment?

Mr Hunt:
The reason there is so much pressure on A and Es is the disastrous GP contract negotiated by the hon. Lady’s party in government, since when — I do not know whether she was listening to what I said earlier — an additional 4 million people every year are going to our A and Es. That is what is causing the huge pressure, and that is what we are determined to put right.

Lucy Powell (Manchester Central) (Lab/Co-op):
As we have heard, A and E waiting times are at their worst level for a decade, yet we hear of proposed A and E reconfigurations based on tackling so-called inappropriate presentations. Does the Secretary of State agree that that approach is the wrong way around and that he would be better off tackling why people are going to A and E first, before he embarks on any reconfigurations?

Mr Hunt:
That is exactly what we are doing. We are looking at the root causes of the fact that admissions to A and E are going up so fast — namely, that there is such poor primary care provision; that, as we discussed earlier, changes to the GP contract led to a big decline in the availability of out-of-hour services; and, that health and social care services are so badly joined up. That is how we are going to tackle this issue with A and E, and that is what we are doing.

Read the full transcript from Hansard here.

 

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Readers' comments (58)

  • If he wants us to see more patients, he should stop offloading all this extra non-clinical workload

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  • And NHS 111 is an improvement?????

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  • Let common sense prevail

    Sometimes I feel the need to comment on the strategies of politicians because I don't believe that they are adopting the most productive stance on this issue or that.
    On this occasion I can say nothing. I can only sit here looking at the screen with my jaw hanging somewhere south of 'gobsmacked'.
    I have never been one to call for the resignation of any politician over solitary issues or differences of opinion, but when you stand in the House and display such a remarkable lack of understanding of your portfolio, then it is time to bugger off. This man is an idiot and he has NO credibility within the profession and I suspect next to none with the general public.
    Since 2004 Out of Hours care has been the responsibility of the Government, not of GP's. If it is a shambles and unfit for purpose then that is of your making, not ours.
    I agree that GPs would make a much better fist of it than you can, Jeremy, but we are not about to volunteer to take on your responsibilities. We have more than enough of our own.

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  • Usually two reasons are given for any ongoing problem for which the coalition government would like to deflect blame:

    1. Labour
    2. Europe

    As it would be difficult to blame rise in A&E attendances on Europe (although "health tourism" is a possible argument), Mr Hunt has chosen to place the blame on Labour, via the GP contract changes made in 2004.

    Note that when statements are made for the purposes of political expediency it does not matter whether any part of the statement has any basis in fact.

    The fact that this man was made Health Secretary tells you all you need to know about this government's plans for the health service.

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  • How out of touch this "Murdoch's cheer leader" is?

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  • Hunt but name, Hunt by nature.

    Jim Naughtie was right.

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  • David Bush - I could not agree more wholeheartedly. I am so incredibly disheartened by Jeremy Hunt's abject lack of understanding of his portfolio that I have set up an e-petition on the government website here:

    http://epetitions.direct.gov.uk/petitions/47740

    I would urge anyone interested in seeing this buffoon go to please sign it.

    (And I'm quite happy for the GMC to see my online opinion represent the view of the medical profession to boot!)

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  • Alexander Thorntonsmith

    I have signed your petition.

    My suggestion would be to try to get a bit more publicity for it, perhaps with a national newspaper.

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  • Tom Caldwell

    HUNT........ say's it all really.

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  • All part of a softening up process (you hold the GP while I hit him) to enable Hunt to impose a 24 hour contract and make us responsible for the whole thing again.
    If he does - will the last GP in the UK turn out the lights please.

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  • Why an additional 4 million people every year are going to our A and Es?
    Two main reasons
    1.Lack of appointments with GPs
    2.Lack of confidence in GPs (they go to A&E to see the "real doctors" - what a shame.Public confidence in GPs are not great.Its a shame but true)

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  • Is this a joke! Is this guy for real?
    Is he clueless or just trying rile up general practice or baseless foundation to screw GPs more....

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  • @anonymous 8:59, you obviously have no idea what you are talking about...please don't post baseless comments just to stir up reaction

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  • @9.00,9.03.I respect you guys opinion but If you have worked in A&E, You know what i am talking about.

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  • Who is to blame if there is a lack of capacity in general practice ? The government pays GPs £60 a year per patient to provide the service. It does not buy enough care. The situation is only going to get worse as older GPs are retiring early and younger ones are emigrating. Newly qualified doctors are not entering general practice. Perhaps Jeremy Hunt needs to fund the extra capacity that is needed to look after an ageing population. He certainly needs to stop alienating GPs if he wants them to help him out.
    I'm quite out of goodwill and should he try and give us back OOH that is my line in the sand. I'd rather stack shelves.

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  • If GPs are to blame, and the hard evidence is lacking, but again IF, then lets be honest enough to blame the 2004 Contract as a whole.
    The fact that this Adminstration has made it even more toxic and had the gall now to impose it doesn't hide the uncomfortable fact that it was flawed from the outset.

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  • @Anonymous | 16 April 2013 8:59pm

    There is some truth in what you say.The main reasons they go to A/E:
    1.There is a genuine emergency/trauma
    2.Lack of confidence in GPs.Want to see "real" doctors
    3.Because they can afford to i.e:its free!
    4.Government,media,charities,pharma all drumming up expectations:i.e get seen quick incase there's something serious.But there's no increase in GP resources so they flock to A/Es

    But rather than tackling the fundamental issue,namely one of a complete disconnect between supply and demand,in a marxist institution the politician makes GPs an easy escape target.Unless we have a radical overhaul about how we fund our health system these kind of political shenanigans will continue.

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  • Petition signed!

    I've worked in AED. In fact I've done so much in AED, I've done everything from reduce elbows, apply plaster, direct CPR resus, drain abscesses, stitch big (I don't mean a couple of stitches, I mean BIG wounds), and even tried couple of intubations. Something many AED doctors no longer do. I'm a GP now, and I'm ashamed to admit when I worked in AED, I used to think I was the "real" deal and the GPs knew nothing. I was very young and immature than.

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  • Roger Leary @8.13pm has got it in one.Hope the BMA are more successful in dealing with this than recent spats with DOH.

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  • So the Minister does not read his own evaluatuions on the 111 Pilot, showing the increase in 999 ambulance recomendations?
    Let us be thankful the 111 launch is partialy aborted by NHS direct failings in call handling.
    If the Minister wishes comissioning GP' s to control AED attendances the only unanimous evidence based intervention to show a reduction is to defer 111 indefinitely, and remove it where it exists.

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  • The main reason more people go to AEd is the rising social disconnect and the attitude of
    " Of Course its an emergency;Its happening to me!"

    I greatly appreciated my last call from AEd berating me for the fact my patient was choosing to go to AED with sore throat "because "you won't give them antibiotics".
    I am sorry but I can maintain my standards of approprate practice.
    If idiots with vrial sore throats want to go to AED- and presumably wish (and perhaps get given) Ab inappropiately- then it is not my clinical issue as a GP.

    "As a Comissione"r we need a national
    " Poorly performing patient program" we can refer them to for attitudinal readjustment, not a poorly perfoming GP issue.
    How can I have confidence in a Minister who cannot perform the most basic root cause anlysis?

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  • Having read all that Hunt the Ignoramus has said and the pathetic attempt by some to lay the blame for increased A&E attendences on GPs, it is but inevitable that, all of this arguement about 'the worried well' versus the really unwell, could be sorted by charging an assessment fee (even as little as £10.00) with exemptions for OAPs and children only. As for HUNT, the hunt is on.....

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  • Assessment fees are out of the question as this would undermine the ethos of the NHS. I am surprised anyone with the nation's health at heart would suggest such a thing.

    Anonymous - your lack of a rudimentary grasp of grammar suggests that you are either North American or did not pay attention in school. In either case, this undermines your argument.

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  • 'Poor provision of GP services.'
    The health service always lacks simple arithmetic.
    Right then, How many patients should a GP see safely in any day, in a week, in a year that is @ good provision'
    A Which magazine survey also critical of GPs stated that the GP saw 42 patients X 10 minutes = 420 running an hour late = 480 = 8 hours of face to face consultations.
    There is 5 hours of paperwork = prescriptions, letters etc to follow.
    So, Mr Hunt, you tell us what ' good provision' is. Tell us hours, numbers etc. Please.

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  • Perhaps it's worth reacting to Jeremy Hunt's statement not the Pulse tabloid headline - if the problem is lack of primary care provision (what he actually said), then use this to campaign for more GP places / practices.

    Or you can go down the anger rant attack route...

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  • Bob Hodges

    If that's what Hunt actually said, and supposing that's also what he actually meant, then how do the recent pension changes, imposed contract changes and utter lack of investment square with his wish for wider primary care provision.

    You CAN'T do it without GPs, and successive governments who thought they could have fallen by the wayside. Politicians share tha same arrogant - they they they will succeed where others have failed (doing the sames thing) because it's THEM DOING it.

    When all the old GPs have retired early, and all the young full timers have emmigrated, who's going to 'improve' primary care provision?

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  • "4 million additional people have been using A and E every year" since the new contract according to Mr Hunt. How many additional contacts have there been with GPs, in and out of hours,over the same period?

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  • General practice = £60 per patient per year regardless of number of visits
    A+E = £60 per patient each visit

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  • @anonymous 9:36, politicians should have the nations health at heart...not GPs.... I am a GP and want to get paid a reasonable amount as a professional, not continually screwed by this government.....general practice needs to go the way of dentists and charge charge the governement for each episode of care and then maybe theyll realise

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  • I think its time to move to contract based on activity rather than block 60 pounds per patient per year.
    I will be happy to see as many patients as required for the activity

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  • Simply build more GP practices onto the side of A+Es. Problem solved!

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  • This is exactly what they want. Health care professionals in all services snarling at each other. In my hospital we are not just seeing vastly increased footfall but greater need for admission. Far higher incidence of resp. issues, some in otherwise healthy young people. Could we be seeing the collision of environmental effects and austerity. Oh and 111.

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  • If it was so badly negotiated, why has THIS governement promoted the person responsible for negotiating it from the governements side?

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  • Some politicians have no idea.Remember when Kenneth Clarke described ambulance drivers as "glorified taxi drivers".Like the others Mr Hunt is a career politician.He's out to score as many populist points he can until his next job promotion.

    Unfortunately there is very little we can do if the government keeps treating us like crap.Sure we can opt out like the dentists but there aren't that many paying punters out there to keep us all in our jobs.Alot of dentists are finding this too and are now increasingly accepting NHS patients.

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  • Ah, the good old days when doctors used to do all their own oncall, know all their patients personally.... and when the policemen used to know all the local scamps and just clip them round the ear when they did wrong, and we had real English money.... I moved from a small town in Scotland in 1998 where out of hours was done by a co-operative to a city in England. Out of hours was subcontracted out and had been for years, and my partners didn't do their own on call. I think the main problem with A&E attendances is demand, and unless this is addressed, other solutions are doomed to failure.

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  • How sad it all is. I retired exhausted at 58 having spent over 30 years working as a partner in the same practice. [Fortunately I made a good decision having bought added years]. I actually felt guilty having to give up out of hours and predicted that it was the thin end of the wedge and the death knell for genuine family medicine, but eventually like many saw it as a path to some sort of freedom for both myself and my family. Little did I realise what was in store, and sitting on the side lines can only feel sorry for those of you like me who simply want to be family doctors. Good luck to all of you.

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  • As our RCGP head said on a BMJ podcast - "our poor, poor profession"
    We're doing an unlimited service for our patients for just £80 per patient per year (one tenth of the cost of a one day stay in hospital) which is untenable.

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  • Our profit per patient per year is £ 40.00. The best in NI is £ 52.00. Check anonymous data with Bridge accountants, Belfast.
    For 7 consultations a year - £ 6.00 each. Only 60% of workload = £4.00.
    Take away tax and NIC = £ 2.00.
    They think we are white elephants sitting in our ivory towers, counting out the money. Shoot the white elephant, you may kill the golden goose.
    Private medicine is expensive. Believe me, I have experienced it.

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  • Here is the puzzle
    Any GP that can retire is leaving. The rest say they are being murdered with work saturation.
    Mr Hunt and his friends think there is inadequate provision of GP care.
    Who is right ? Well, let us put a figure on what either side might consider a safe workload. That way, you can tell if we are either lazy, golf mad overpaid GPs or just worked to the ground.
    Define normal, acceptable workloads. Please Mr. Hunt.

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  • Its about time we were paid per patient event rather than the current status quo.Like the hospitals are then we would see if the government are getting value for money.

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  • Agree with sentiments of david Bush. Have signed petition.

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  • The largest factor in use of A/E is the distance a person lives from the department.

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  • I too have signed the petition but would like you to arrange another for us to vote out all politicians as they are nearly all self interested ignorant pratts. Alison Seabeck excepted.
    I notice that Hunt's DoH said in its statement after his comment elderly care should be improved by GPs. I guess (but don't know) that like in my area it will mainly be the young going to A&E as the elderly know how to treat minor illnesses and manage symptoms better- we are made to look at this data regulalry and cannot see anything we have control over in the statistics

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  • This grinning ambitious career-politician is really not fit for purpose. Apart from his ignorance I understand he is on record as suggesting that the NHS is a waste of space.

    But I feel that as well as this general animosity to the whole organisation, he and his tory coalition are trying hard to demolish general practice, so that, unless there is a huge fight to prevent it, in a few years' time the notion of a 'family doctor' could be but a wistful memory.

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  • Hunt's PDP for 2013/14 surely needs a bit of work !!!
    Talk about PUNs & DENs, but what about Jeremy Hunt's PENs ( Politicians' Educational Needs !!! )

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  • We should spread awareness using all available media outlets on the true mess of the situation caused by past/present governments! We are always playing catch up, defending harsh remarks made in political spheres, in which we have no advocate. Times are desparate and maybe we should try the bat-signal!

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  • Hunt looks like smiling a teflon skinned son of Murdoch that never was. Branson et Al waiting in the wings.They are trying to steal patient goodwill by driving Gps into the ground. Mass resignation is what is called for. Make them sh@t their pants.

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  • Hey folks - there is simply a gulf between GP opinion and politician's. Truly, they believe GPs are overpaid.
    I remember the old days - 9am fri to 5pm mon - 80 hours on call with 3-4 hours sleep.
    No thanks, Mr Hunt. slavery is long gone.
    Let us define a mutual time/ motion study, even get the the daily mail- how many patients should we see safely in a day? You tell us GPs how many hours - how many patients a day. Go on Mr Hunt.

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  • Yep, total and utter nonsense. Has anyone in the DOH the common sense to realise that it's multifactorial and hardly any of it can be addressed by GP. Firstly they constantly mix up unecessary A+E attendance with OOH, the two things are separate.n Our A+E depts are full because of a) increasing Eastern European immigration, where patients seem to expect use A+E. b) A press that spends its life scaring patients to death about what to do with non-specific symptoms like headache rash and chest pain, and c) and in my opinion the most significant, A+E depts in Foundation Trusts make money. A CEO in a Trust wants A+E full, but just at the 4 hour limit and his acute wards similarly stocked. That is why the 30+% of patients that turn up with non A+E issues are not diverted to Primary Care. It would be like Tesco telling you at the door to pop round to Lidl. You're in, you're seen, you're overinvestigated, thus cementing the belief that that was where you should have gone. The patients like it and go next time. If you want a single basic issue that needs sorting out, it's that. It says A+E and they should send anyone else back to GP services.

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  • I am not a GP but a very weary ex PCT person. I predicted that this recent reorganisation or should I say de-nationalisation of NHS was set up to fail in order to undermine the position and confidence in GPs so I think this statement by Hunt is just the start. You shouldn’t let it spark any rifts between primary and secondary care professionals as you are the only ones that know what’s really going one and can keep health services safe for us all.
    You are the front line and you all know what needs to be done to make the NHS sustainable and effective. We have to break down the silos that have built up between services You may not all agree with the new CCG system but you must use it now to really look at patient pathways and patient behaviour
    Don’t lose this opportunity to really change things if you do many of us have lost so much for nothing.

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