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Independents' Day

'Named GP' plans thrown into disarray as minister suggests practices can devolve care coordination to district nurses

Exclusive Plans to rollout ‘named GPs’ for all elderly patients from April have been thrown into confusion after a minister’s suggestion that practices could devolve the coordination of care to district nurses was challenged by the nurse’s representative body.

Health minister Dr Dan Poulter said that named GPs would be tasked with working with other parts of the NHS to ensure that all patients aged over 75 had their care coordinated by the ‘most appropriate professional for that individual’s needs’.

In a parliamentary response, he said that while GPs might be the best placed person to fulfil this role, in ‘most instances other professionals are likely to be better suited to take on the care coordination role’, including district nurses.

The suggestion that GPs can delegate care coordination comes despite the Department of Health initially stating that coordination of care would GPs’ responsibility, as it hailed a move back towards ‘old-fashioned family doctors’. The responsibility is due to be introduced in the new GP contract in England from April.

But the DH said that there was ‘no inconsistency’ and that GPs must take ‘lead responsibility for co-ordinating a range of services’ so that elderly patients get the best care.

The Royal College of Nursing challenged the idea that care coordination could be shared, saying that ‘significant investment’ would be required for community nursing teams to take on the additional work.

Dr Poulter told MPs last week: ‘Named GPs will be expected to work with associated health and social care professionals to deliver a multidisciplinary care package that meets the needs of the patient. In some cases this may include working with colleagues such as district nurses, who are well placed to visit patients in the community.

‘Further to this, it will be the responsibility of the named GP to ensure that their patients have effective care coordination in place by the most appropriate professional for that individual’s needs. GPs may be well placed to fulfil this role, but in most instances other professionals are likely to be better suited to take on the care coordination role.’

But his comment that GP practices could devolve care coordination to district nurses was rejected by the RCN.

An RCN spokesperson said: ‘The real issue here is that GPs don’t own or direct district nurses and the community services have to be properly commissioned to take the new service ideas into account. People over 75 who have needs should have a proper person-centred plan of care that identifies the appropriate services they need.

‘If we are going to simply pass the responsibility on to community nursing teams, then there will have to be significant investment for that.’

But the GPC said they ‘hoped’ community services and nurses would work with named GPs.

Deputy GPC chair Dr Richard Vautrey said: ‘There is a difference between the named GP and the care co-ordinator. The former has to be a GP in the practice and is the person who will oversee care delivered. The latter is the person most involved in the direct care giving and could be someone in the practice or the wider health care team, such as a district nurse or a community matron.

‘The practice has no management responsibilities of others outside the practice but this is more about formalising the reality for that patient, and where a community nurse or social worker is the one most closely involved with a patient it would be hoped that they would work in an integrated way with the practice. We need to move to a point in the future where there is greater cooperation and collaboration between members of the wider primary healthcare team, working with a common care plan.’

But Family Doctor Association chair Dr Peter Swinyard said: ‘Until we actually get some contractual buy-in, some contractual tie-down, I think that working on hope is cloud-cuckoo-land, really.  

‘The Government is not a nice, sweet, benign organisation who value GPs and think everything GPs do is wonderful and they should make life easy for us. If the Government writes the rules in such a way that they can screw us, sooner or later they will. So we have to be very careful to ensure the rules are written in such a way that the patients benefit and the GP is protected from unreasonable demands.’

A Department of Health spokesperson said: ‘Under these major changes the buck will stop with GPs for ensuring that older people are proactively cared for better according to their individual needs. But this won’t mean that GPs suddenly start controlling the work of all community health professionals.

‘Whether it’s sharing records more closely or writing joint care plans, the key point will be coordinating all experts to work together closer as team for the good of the patient.’

He added: ‘There is no inconsistency here. We have said all along that GPs must take lead responsibility for co-ordinating a range of services so that vulnerable patients get the best care. But of course there will be frequent instances where it is most appropriate for another health professional to continue playing a leading role in delivering an individual’s care, based on their personal needs.’

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Readers' comments (26)

  • Ha ha even the Govt don't understand their own plans

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  • Perfect example of those with 'good ideas' meddling in the running of services that they clearly do not understand! No wonder the NHS is struggling - here's a good idea lets get rid of political meddling and let health care professionals actually do their jobs!

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  • DNs - they are struggling with their own work load and even have waiting lists !!!! Perhasp we can suggest the minister delegate their work to us - !!!!!! and the pay attached to it !

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  • I cannot see that this will be possible, when all the doctors in this area do not work five days a week (and I suspect this is not a unique scenario!).

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  • I would not be too sympathetic with the RCN and district nurses. There is widespread evidence of poor productivity, too much time spent in offices and little use of modern technologies. You need to ask yourself how many patients you see every day and how many does a district nurse. The RCN is right in saying the service needs to be commisioned more effectively. There is virtually no data available in comparison to primary care and yet budgets are often greater than primary care. Well done RCN for putting the spotlight on district nursing!

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  • "If the Government writes the rules in such a way that they can screw us, sooner or later they will." Absolutely brilliant Dr Swinyard!!!

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  • Desperate Dan

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  • Oh divide and conquer eh? GP v DN, DN v GP.
    How long before we have a DN recruitment and retention issue? How will GPs manage DN commissioned by others when it is their 'named' name the patient sees? All this does is state that the government accepts that GPs will not be able to deliver this promise (jn a year of election) but they will still be held accountable if it isn't! In effect GPs become the managers of the DN service too! Glad we got rid of all these bureaucrats if GPs have so much time to 'coordinate' every bit of the healthcare system - they must have been chronically underworked!

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  • I've seen a report that DNs in liverpool last year were seeing on average 3.5 patients a day and spent more time in their offices doing pointless paperwork than seeing patients. perhaps its time DNs did work for and as part of the GP team? might lead to huge productivity gains? similarly physios - my practice used to directly employ one in fundholding days she would often see 20+ patients a day - including offering a same day urgent service. the local physio service - as nice as the physios are rarely see more than 10 a day and loads of their days are now mandatory training, appraisals etc. Community trusts are one of the worst culprits for inefficient working practices. imho.

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  • This sounds like - I'm going to be held responsible by the patient, the family, the courts, the coroner, the media, the politicians when anything goes wrong, but i wont have the power/authority to get anyone to do anything...No thanks.

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