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GP leaders to consider taking back OOH responsibility

By Gareth Iacobucci

GP leaders are looking at how the profession could take back a degree of responsibility for out-of-hours care, after a fierce debate at the LMCs conference.

In a knife-edge vote, LMCs backed a motion calling on the GPC to consider moves for GPs to take on responsibility for commissioning out-of-hours services.

The vote, which split the GPC, signals a dramatic shift in the debate over out-of-hours care. It aligns the position of GPs with that of the Conservative party and the NHS Alliance, which both want to see GPs gain commissioning responsibility from PCTs.

LMCs voted by 50% to 48% – with the other 2% abstaining – to back the motion, which recognised that most GPs had welcomed the out-of-hours opt-out, but said: ‘Conference believes primary care organisations have generally failed to deliver effective services.

‘It calls on the GPC to consider resumption by GPs of the responsibility to commission out-of-hours services, with the attached resources to do so.'

Dr Michael Dixon, chair of the NHS Alliance and an adviser to Lord Darzi, described the vote as a ‘landmark'. He said pilots could be set up in volunteer practice-based commissioning ‘hotspots' to gauge GPs' readiness to take on commissioning responsibility more widely.

But questions remain over how a transition could work in practice, with the vast majority of GPs strongly opposed to taking back any personal responsibility for out-of-hours care.

GPC leaders said any move would depend on the success of PBC, which is only up and running in England.

Professor Chris Ham, professor of health policy and management at the University of Birmingham and former head of the Department of Health strategy unit, said Lord Darzi needed to offer GPs much stronger incentives.

‘Unless GPs can see it's worth their while to take on more responsibility for commissioning of care, there's no way they can be persuaded to do so,' he said.

Dr Alan Stout of Northern Ireland Eastern LMC, who proposed the motion, said that organisation of out-of-hours care ‘needs to go back into primary care', but not on an ‘individual responsibility' basis.

But Dr Will Harris, an out-of-hours salaried GP and Bro Taf LMC member, argued the current system was working. ‘Show me the evidence other than anecdotal whingeing that it isn't. We are delivering.'

After the debate, GPC chair Dr Laurence Buckman said: ‘It's the closest vote we've had. The GPC is not remotely unified on this. We'd have to think carefully about the implications. We're not talking about GPs working hours, we're talking about GPs commissioning out-of-hours through PBC, and taking commissioning back from PCTs.'

Dr Dixon said: ‘It's a stunning, very progressive vote and the BMA should be congratulated on it. It's an extraordinary vote in favour of PBC.'

How could GPs take back out of hours:

• PBC clusters could take control of out-of-hours commissioning
• Government advisers suggest pilots could be set up in volunteer PBC ‘hotspots' to gauge GPs readiness to take on commissioning responsibility more widely.
• Problems over how changes could be implemented outside England must also be addressed – with PBC currently in England only
• Another barrier is existing deals with private companies across the country, some signed only in the last few weeks

LMCs vote on OOH responsibility

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