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Health secretary announces 'one-stop' plan to revolutionise role of GPs

Health secretary Jeremy Hunt has announced a new programme aimed at moving more patient services to GP practices from hospital.

Mr Hunt said that under his ‘GP one-stop programme’, the NHS will be going through ‘condition by condition’ to see which can be handled in general practice rather than secondary care going forward.

Mr Hunt said that the NHS has to ’get back to basics and think how many issues and problems could actually be solved with a visit to a general practice’ rather than ‘sending someone to the back of another queue’.

Speaking at the Best Practice conference in Birmingham today, he said: ’I think it is quite sobering to note that the entire outpatient budget for hospitals is around the same as the entire general practice budget.

’[But] I think as far as patients are concerned they would much prefer it if a lot of those problems were sorted out inside general practice.’

Mr Hunt said his plan would include a range of conditions, such as for example diabetes.

He said: ’So you will be hearing more about what I am calling “the GP one-stop programme”, looking at areas like diabetes, end-stage renal, and many others.

’We are going to go through, situation by situation, condition by condition, and ask what barriers we can remove centrally to allow more of this work to happen in general practice.’

He admitted that this meant asking GPs to ‘do more work’ but said that they would be ‘paid for doing that’ and argued that it would also ‘make life more rewarding for doctors’.

And, aside from being more satisfying for GPs, Mr Hunt said the model will allow patients to be seen more quickly.

He said: ’It’s not just that it’s better for patients, because they’ll get the care they need more quickly, but also its part of making the process of making life more rewarding for doctors, because it think the last thing a doctor wants to do is send someone home without having sorted out the problem.’

But he added that the Department of Health was looking at how it would fund this shift in workload.

He said: ‘That means looking at payment systems.

’Because we are asking GPs and practices to do more work, they need to be paid for doing that. It also means removing some of the inflexibilities.’

The news comes as NHS England is in the process of developing a new voluntary GP contract for large-scale multidisciplinary GP practices with 30,000 or more patients, which aims for practices to employ a wider range of healthcare staff.

But it also comes as the GPC has been successful in convincing NHS leaders to amend hospital contracts to stop ‘workload dump’ from secondary care colleagues, amid unprecedented pressure on GP practices.

GPC deputy chair Dr Richard Vautrey said: ’

Many practices and GPs already do this, caring for the vast majority of their diabetic patients. However this shifted work is not matched and supported by shifted resources and moving funding to make such services sustainable is what is really needed.’

Readers' comments (57)

  • Not more work Jezza! Are you trying to kill us?

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  • now we have it confirmed..he is indeed batshit crazy..paying us more is no help you fool..WE NEED MORE GPs

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  • Does he no get it we are dying here, cant he leave us to die in peace,why the torment!

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  • ’I think it is quite sobering to note that the entire outpatient budget for hospitals is around the same as he entire general practice budget.

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  • Well done my multispecialty community provider vanguard idiots, this is the crap that is going to fall onto you and the rest of general practice for peanuts.

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  • The squeals of protest(endorsed and embellished by prominent media drivers) from influential secondary care leaders, at the proposed threat to their own limited income stream will probably mean we won't even get the tuppence JH will promise us. (He certainly knows just how to bolster freefalling NHS morale!) Of course if hospitals sent their precious staff to man clinics in GP there could even be a win-win.

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  • The only way this is going to work is to huge number of secondary care consultants working in chambers or being employed by a mcp organisation.
    However all this is repeating conversations that have been talked about for at least 20 years.
    Unless it is adequately funded / man powered it just isn't going to happen.

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  • OMG. This man doesn't have a clue. I have a friend who has just been employed by NHSE looking at this. She's a psychologist who survived for 6 months in actual patient care. Much as I love my friend she doesn't have a clue.
    This is the grave concern, that people who have no clue have the funding and power to come up with this crap

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  • Good luck doing inulin pump clinics and dialysis in your spare rooms guys. Your great leaders have convinced our jezza that you're a limitless resource, and everyone is secondary care is a money grabbing lazybones. Now we can all sit back and let you do the graft. Lovely.

    Except you'll fail, and we just get to mop up the mess when it alll goes wrong. Just like the admissions avoidance, which simply increased referrals.

    And yes, mr GP trainer, hospital staff are a scarce and precious resource, which needs to be deployed where they are most effective, it just to make your life easier. Which for the most part, is not doing primary care clinics for the privileged few.. 40% of all advertised consultant jobs are unfilled at the moment, and we need to look after our inpatients seven days a week. Unlike you, we haven't shirked that responsibility.

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  • How utterly depressing.

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  • Anonymous | Work for health provider20 Oct 2016 6:08pm
    I think maybe you forgot to take your pills this morning. What are you bleedin on about?? Cookoo

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  • Great. I can't wait to manage the most complex diabetics and renal failure patients to name few, for peanuts, whilst the hospital consultants can crack on with important things like their private clinics

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  • Vinci Ho

    While the rise in workload is the obvious issue (with or without so called adequate funding) , the bottom line here is transfer of responsibility and hence , liability to us. Crown indemnity is almost indisputable if this is to be the case.
    The level of expertise as well as the bread and butter number of GPs ,are the fundamentals, unless there will be concurrent capacity of specialists in the same locality in the community . As I said before , the meaning of resources is including expertise , manpower , time and lastly, money . All four must be co-existing NOT one thing leads to another .
    Ultimately , general practice is widely exposed as a target shield to be receptive to all arrows of demand fired from the public .......
    Where is Simon on this? He needs to give his statement .......

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  • I thought 12000 more GPs were needed according to last weeks Pulse.

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  • surely we GPs only refer things to secondary care that we cant manage and that definitely includes end stage renal failure. we already do most of type 1 DM other than those on insulin. I don't think were competent to do much more than we do. What is he trying to say. that we should work outside of our competency and put patients at risk?

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  • He is trying to say that he wants to bring the whole of the NHS to its knees as fast as possible so the NHS will fail and he can get his directorship of PPP and major cash windfall.
    Look at all the government edits over the past few months... how many dont fit into this plan? Exactly!

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  • We are Capitation contract mugs. The shit will keep piling up......

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  • What Jezza is trying to say:

    "We would like to cut costs and ask GPs to do the work for less than we pay secondary care"

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  • Saying words is very different from actually making us implement them. Please. Don't be so passive as to feel that this man's imaginations will suddenly become contractual obligations. Given his performance at the recent court hearings, the worst he can do is suggest his ideas to the nhse stooges.

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  • No offence intended but the GPs I encounter are clueless* about managing insulin and diabetes care in general practice amounts to little more than a tick box exercise where qualifying for points means more than providing decent patient care.

    Why bother training diabetologists for years if the work can be done after a 6 month rotation as a junior doctor?

    And as per usual - do the patients on the receiving end of this "initiative" get any say in where they want their care to be performed?

    *Not to say that GPs couldn't become excellent diabetes specialists but if they spend a vast amount of time undertaking all the training and gaining all the required experience then they wouldn't have any time to be GPs.

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  • ’We are going to go through, situation by situation, condition by condition, and ask what barriers we can remove centrally to allow more of this work to happen in general practice.’

    But he added that the Department of Health was looking at how it would fund this shift in workload.

    He said: ‘That means looking at payment systems.

    ’Because we are asking GPs and practices to do more work, they need to be paid for doing that. It also means removing some of the inflexibilities.’

    OK, so QOF will be removed (with expectation that we will still carry out all this 'good practice'), along with significant funding, and we will have to re-earn it by jumping through yet more hoops...

    Oh joy.

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  • 1. Not enough GP's to do current definition of General Practice.
    2. Not possible for a doctor to be a specialist and a general practitioner, as they are both roles that require years of training and a full time commitment to keep up to date.A GP with a special interest in a subject is one who knows more than the average GP , but unlikey to be a consultant level.
    3.Is he trying to turn GPs into consultants , ones that can see patients in 10 minutes with no nursing staff? If so he needs to say and so we know to start a different specialist training. Or more likley retire.

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  • I want to be a GP not a specialist,being a specialist would be very very dull.

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  • Hunt has made a suggestion here which merits investigation but doctors like everyone else require to be paid for what they do and training updates may be required and paid for in some doctors' cases so that they can actually perform the extended services envisaged. Keeping patients out of Hospital when possible may also reduce the incidence of Hospital Aquired Infections. Hospital treatment is of course very expensive and has to be restricted to patients whose illnesses and conditions must be treated in Hospital. But one cannot have any good clinical services without them being paid for and the Government is clearly already underfunding the NHS because we are not training enough doctors and waiting times are again increasing. Having a one stop shop will require additional resources because it may require surgery buildings to be extended and additional nursing staff plus additional equipment costs. Hunt should always be confronted with the costs of his proposals before publicising them. We won't get one stop shops without considerable investment.

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  • Talk about failing to grasp the basics!
    THERE ARE NOT ENOUGH GP's or PRACTICE NURSES OUT THERE TO COPE WITH THE CURRENT WORKLOAD and those of us reading this will be trying to get out of GP land ASAP.

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  • this is one area that everyone here is getting wrong.

    This is what GPC and RCGP should be doing:

    take the bull by the horns here and make a grab to control medical training in relevant areas.

    I.e if the plan is to move Dermatology, pain clinics, gastroscopy(etc) into community then take control of the training structures. there is huge potential to really enhance the purely medical aspect of General practice.

    I spent sev years trying to do this but HEE wouldn't even consider this.

    No-one can be asked to deal with issues beyond their training and skill - so the noise about dumping work can easily be bounced back. But if GP's take control of several traditional hospital roles and the training infrastructure then it cold strengthen general practice

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  • What we all acknowledge is that General Practice in its current model is not sustainable, nor is that of Secondary Care.
    We need to redefine the clinical paradigm so that we can have the resources(human,technical,financial etc)to enable us to deliver this.
    Infantile whining about "evil Tory plot" gets us nowhere. Our patients deserve better.
    Lets endorse positive changes for the future and liberate ourselves from the Dr Finlay "cottage industry"mindset.

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  • ROBIN JACKSON What we all acknowledge is that General Practice in its current model is not sustainable

    Actually there is no evidence that is true.

    the drive for federation models is ideological and carries no evidence.The Dartmouth group which is driving the 5yr forward view have no experience driving change at this scale, and very understanding of UK GP.

    there is ample evidence that UK primary care can work well( and is working well compared to international standards) and the pressures on it are from external factors ( lack of work force planning, change in demographics, indemnity etc).


    Nothing is sustainable if you choose to define it that way.

    UK GP is incredibly efficient and productive - it is highly likely the MCPs will destroy that

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  • I'm dismayed at the scepticism of these posts! This is doable with all the FREE time we are wasting ....BUT It may involve self catheterisation, nappies IV drip and a whip.....

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  • complex heart failure case. heart failure nurse wants to add in yet another poison. wants me to prescribe it but she'will take responsibility'.
    I advised her to go and chat with the cardiologist at the trust that employs her.

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  • Shurly eds the headline should Jeremy announces one stop plan to expend with GP's services?

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  • Can something be done about all the 'works for an unspecified employer but very keen to post on here none the less' folk posting their half informed gems of wisdom. It's weary making

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  • You are all pathetic spineless moaners. I managed to perform 2x CABGs whilst dpoing telephone triage and have 3 people in my car boot being dialysed whilst I visit a nursing home for their daily ward round.

    Please can I have a gong Jezza?

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  • Classic Dunning Kruger effect. Too inexperienced to recognise one’s own inexeperience. Even after several years in the job :-((

    https://en.wikipedia.org/wiki/Dunning–Kruger_effect

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  • I managed to grow some CABbaGes in our practice allotment. We could use the IVy to give antibiotics and thrombolytics and my CARDIgan is very useful for helping broken hearts.
    I could go on like this for hours, but I have some real GP work to do

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  • Jo, I am sure "working for a pharmaceutical company " gives you a clear insight into General Practice but I can assure you in my neck of the woods if you suggested to the GPs here that they are going through the hard labour of merging and federation just for "ideological " reasons,they would probably ask you to "step outside " for a short "UKIP"-style "discussion".
    They are doing it firstly out of a sheer instinct for survival from a model that is clearly not sustainable, principally in recruiting terms,and secondly because they believe collaborative working will benefit patients.
    Neither you nor I will know whether they are right for several years but in the meantime let us salute their carpe diem courage.

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  • I'm not against the idea in principle. However, there are many practical problems which JH seems to ignore.

    1. There are not enough GPs to service the current demand, nevermind expanding service.
    2. Who will be responsible for employing the work force. I, as a partner, is personally responsible for the finance including paying for redundancy. NHSE seems to change their target at a whim and there is no way I'm talking risk of employing workforce with salaries in triple figures.
    3. There is no way a generalist can do 4 day clinical work and keep up to date on par with the specialists in all of the clinical specialties.
    4. Smaller surgeries with personal care often gets the best patient satisfaction rates, referral rates and AED attendance rates. This suggests patient care isn't about one stop shop or number of specialties offered at one practice.
    5. I assume he is expecting any practice with smaller list size (say below 30k) to close our merge? Who will be managing this, including the existing premises owned by the GPs?
    6. He does realize in NHS, bigger = less efficiency? Not only will be have to give up on nhs efficiency savings, he'd have to look for extra resources to service the fall in efficiency with this model.

    Perhaps Mr €ant might want to stop thinking about how he could trick the general public for more votes with ear pressing sound bites such as this and start acting as a responsible officer of health for the country and consider realistic solution?

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  • Get behind Mr Hunt you GP shirkers.

    Haven't you heard that there has 'never been a better time to be a GP' and 'we are ideally placed' to manage*:
    End stage renal failure
    Complex type 1 diabetes
    Boiler checks for the eldery
    Free Shotgun licence monitoring
    Gambling addiction
    Free nursing home daily ward rounds
    Verifying death in the dead
    Community hospital management
    A&E backfll
    OOH work
    Extended hours
    Saturday and Sunday urgent wart freezing clinics

    *courtesy of the fantasy of various RCGP chairs, , or with the tacit backing or failure to prevent by workload dumping by BMA GPC.

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  • Anonymous | GP Partner21 Oct 2016 3:57pm

    'I'm not against the idea in principle. '

    this is part of the problem - if you give an inch they will take a mile. and if just one GP somewhere accepts it they will take that as an endorsement and roll it out. the root cause of the problem is an open ended contract. either accept that the state can do what they want when they want or leave.

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  • Indemnity is going to be even more eyewatering

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  • Anonymous | Sessional/Locum GP22 Oct 2016 1:59pm

    Agreeing concept has a basis is not the same as accepting we will do it or practical to do so. We need to differentiate our business obligation which needs to consider practicalities and clinical obligation which requires us to offer effective care for our patients. We must not let incompetent health secretary stop us from thinking how we can improve care.

    So on the latter hat on, I agree in principle. But with former hat on, Mr Hunt is talking rubbish!

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  • Yes, a one stop plan for GPs. Just one decision -- and GP work stops.
    Permanently.

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  • The only one stop shop that works is a private one with lots of funding.
    Instant radiology, lab reports and referrals.
    Not one where there is pressure on you not to investigate, prescribe or refer.
    Get real Jeremy! It is rationalized health care.

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  • Another foolish idea worthy of our SoS. The reason why the entire GP budget is as big as a hospital outpatient budget is because primary care is woefully underfunded. Rather than aiming to shrink the outpatient budget to match the GP budget why not have a meaningful needs assessment and discussion about the future of the health service? Cynical me thinks this is just another nail in the coffin of the NHS Jezza has promised to deliver to the Tories for the sake of privatising.

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  • Proof , if proof were needed that Jeremy Hunt is unfit to be secretary of state for health. Perhaps that is why he was given the job. It certainly applies to Capita-inefficiency by design.

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  • John Glasspool

    Does anyone believe funding will follow the new work?

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  • locum work looking more attractive or even Australia - hmm.

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  • About time. A proper structured plan to shift resources out of hospitals into primary care, where they will be much better utilised. However, unless Jeremy can come up with loads more GPs, this won't happen any time soon. I suppose we can manage to an extent with additional specialist nurses, but only the GP can take full responsibility for patients and there just aren't enough of them. The only way to achieve this in the short term is to use a lot of nurse prescribers, pharmacists, etc to take a large swathe of GP workload.

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  • Can't anyone see the problem is a FREE
    primary care NHS
    In 1947 a terrible mistake was made
    primary care should be funded by the patient at the time of each consultation like veterinary medicine
    The state should keep its powder dry for secondary care where it is needed
    By making patients pay for all GP services you would in a stroke
    • reduce demand
    • encourage more doctors to be GP 's
    • make GP land more competitive and each GP will offer a.better service and do more
    Of course anyone on an income of say below 16K a year would not have to pay anything
    Hey presto every problem solved
    A and E depts would shut overnight
    boy would GP's up their game

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