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GPC to propose radical plan to merge all unscheduled NHS care in bid to solve out-of-hours crisis

Exclusive The GPC is poised to publish an alternative plan to improve out-of-hours care, proposing all unscheduled care is merged together and rebutting the health secretary’s call for contractual changes to force the profession to take back 24/7 responsibility for their patients.

In an exclusive interview with Pulse, the new GPC chair Dr Chaand Nagpaul said they would propose that out-of-hours care, walk-in centres, minor injury clinics are merged and work together with the NHS 111 service.

Dr Nagpaul said that Jeremy Hunt’s call for contractual changes was a ‘red herring’ and ‘missed the point’ of how to solve the real problems with out-of-hours care.

He also said that CCGs had not been given real power over the budgets for unscheduled care and that many GP commissioners were ‘hamstrung’ from sorting out their out-of-hours care issues locally.

The comments are the first sign of how the GPC is going to fight back against a concerted campaign from the health secretary to force GPs to take back 24/7 responsibility for their patients.

Mr Hunt has suggested said he wants GPs to ‘sign off’ care for their patients out of hours and that he wants ‘the buck to stop’ with GPs by making them the accountable clinician for all the care their patients receive outside hospital.

But Dr Nagpaul branded the idea was a ‘populist tick-box’ and said that the GPC would be pressing for a different vision for out-of-hours care with all services providing unscheduled care locally working together.

He said: ‘The GPC has recently produced a document we will be publishing, proposing our version, our vision of how out of hours services can work in the NHS. We believe this does offer a sensible way forward that would meet the needs for patients.

‘I think the important thing for out-of-hours is to give GPs the ability to influence the organisation and delivery of out-of-hours services. We think the idea of talking about GPs being personally responsible contractually is a red herring and isn’t actually addressing the problem.’

He added that additional resources and a different model for out-of-hours care was needed: ‘We do not see the sense of having all of these separate players providing unscheduled care out of hours. To have 111 operating as a separate entity, having Darzi clinics seeing patients separately, having A&E minor injury clinics, and GP out of hours all separately.

‘We see an enormous benefit in bringing all the multiple unscheduled care providers together, but also bringing social care into the picture, to create a coordinated whole. We believe this will be able to offer patients the care they need out of hours.’

The announcement is the first big policy statement by Dr Nagpaul after being elected chair yesterday.

Hitting out at the Government, Dr Nagpaul said CCGs have not been given real power over the unscheduled care budgets and that the idea of having a ‘named clinician’ was not something that the GPC supported.

He said: ‘What we don’t want is a system which is either just a token gesture, neither do we want a system that is not deliverable. I think we need to learn more about what the Government wants with this and move away from a populist tick-box that you’ll have a named clinician.

‘We shouldn’t be talking about a named clinician, it is putting an end product before thinking what the needs are. So what I want it a dialogue with the Government about patient needs, patients of all categories.’

 

Readers' comments (31)

  • I would support this stance. Having 111 and OOH providers etc run by different organisations just doesn't work. Much easier to pass the buck and throw things over the fence causing duplication of effort and poor patient expeirnce. Bring them all together. Gets my vote. I can see a few practical obstacles in the way but we can overcome those I'm sure. Let's get behind this and drive this as clinical commissioners and make it happen.

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  • Why are the providers trying to define what the patients need? Who is asking the patients what they need. The GPs do not have that knowledge so why are they trying to define the solution.
    As always-- ask the customer . Wouldnt that be unique for the GPs/ NHS.
    After all GPs are private contractors who have a vested interest in protecting their revenues. Their views are obviously tainted by self interest.
    .

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  • Dear Anonymous. I completely agree that patients need/must have input into this, and indeed in our locality we have already asked their views at a public meeting and our CCG plans to do this over the whole patch. I have to say I do think that GPs have a very good insight into what works best for our patients. We have been in this game for quite some time and really do have our patients' best interests at heart and I am a little diappointed by your negativity, and actuallly I am not saying the GPs should necessarily provide the contracts, but as commissioners they couldcommission from one provider whoever it is to provide this joined up service.

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  • Of course patients should be consulted. But in reality patient demands need to be responsibly balanced with what's possible, what's affordable and most importantly with clinical priorities which put the mosy needy first. Currently too often those that misuse the system and shout the loudest are pulling valuable resources away from people who really need them.
    Misuse of urgent care is one of the biggest reasons it's under pressure...it's time for a bit of responsibility and rationality to return to the way the NHS is used. My goodness if it wasn't for confidentially we'd all have some stories to tell....

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  • Merging various out-of-hours work would muddy the principal issue; patients are now effectively excluded from receiving own GP cover out-of-hours and commonly comment about the trust-undermining impact of this change.

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  • its not a bad idea actually. Its nice to see someone making a productive suggestion about how we might "counter" the governments ridiculous propoganda and headline grabbing rubbish by proposing a sensible idea of our own. This is a good idea in principle but i would be concerned that it would be very diffcult to implement practically. Having said that, one organisation running the OOH care would mean at least a joined up approach to services (you would hope). This would seem to be a better alternative to the suggestions of the people who seem to think we all should be on call 24/7, 365 days a year. Presumably, this proposal would allow for a continuation of OOh being provided by GPs who actually want to do it rather than it being an imposition made from above.
    Anonoymous GP registrar

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  • the comment about " ask the patients "- a lot of us have some expierence as patients with access to OOH care - either for us or for our loved ones.So to state that we can not have any idea about what patients want is nonsense, most likely written by somebody who is fortunate enough to never have been at the " mercy " OOH care

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  • It is easy to ask patients what they want, harder to ask patients what they are willing to pay for. We have a really good participation group with a couple of members who put the brakes on expensive ideas by asking them what services would you like to stop to fund your ideas.

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  • The problem here is not who is running any of it but the ridiculous requests from a large percentage of patients, reading through the hundreds of out of hours reports on a monday has turned into a joke, to quote but a few "i put antibacterial hand gel on my hands visiting a relative and then sucked my finger...have i poisoned myself" or "i ordered my script from my GP on wednesday but i forgot to pick it up so can i get a repeat from you" or " ive had sickness for the last 30minutes what should i do" or "ive just been to my doctors because i wanted antibiotics for my sore throat but they wont give them to me so i need you to" do i need to go on! The sooner people realise that they are causing the out of hours crisis the better. There was a time when common sense prevailed but this "need now ,seen now, instant access" that has been brain washed into previously sensible people has caused what is and will be unsustainable until people take responsibilty for themselves. i used to work for OOH years ago and i can tell you from experience people phoned with real medical need not the pile of clap trap we see nowadays!

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  • If you ask a 3 year old what he wanted, and bought him all he wanted every day, guess how long your money will last? Do you tell your child he cannot have everything he wants and you'll only buy him things which you feel is right for him?

    Unfortunately many patients has the same level of self restraint and understanding of the budgets as a 3 years old. People don't seem to under stand referrals costs money, drugs costs money, MRI scans costs money, operation costs money and even an appointment with me costs money. And not all of it necessarily good or needed for that person.

    But there again, everyone seems to think their unmet needs are far greater than the unmet needs of the society as a whole.

    P.s. I choose 3 years olds as that that age awareness of other's needs hasn't developed yet. I mean no discrimination against any 3 year olds :)

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  • Well said 1014 pm
    And 135am!(why!.....guess it was Friday night)

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  • I hope 1:35 was an on call GP.
    It might be a bit of an eye opener for the public if we all logged on at some point during OOH shift to comment.
    And before some anonymous Daily Wailite suggests its a waste of taxpayers time, do remember medical staff do need hydration and physical needs breaks too!

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  • Yes...for too long we've absorbed the onslaught while being too afraid to state the frontline reality. Those who remember the beginning of the end if 'your own GP covering you OOH' remember all too well why it collapsed. Exponential rises in demand (I remember shocking graphs that convinced me the game was up)...
    We could probably have coped with the rise in complex miltidisease problems but what killed it was a rise in assertive selfishness. The loud selfish and uncaring rode roughshod over the needs of the most needy. Its the same for a&e, the police etc...and its the real reasonsble personalised care was destroyed. We will end up with an industrial sized service..but make no mistake why we ended up there.

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  • Anonymous 7.07PM is right to ask whether GPs have asked their patients. Last month, In the spirit of "evidence-based medicine", I did a straw-poll at a college reunion lunch in a riverside pub, on whether my 11 octogenarian fellow survivors were aware that in 2004, GPs had abandoned responsibility for their historic OOH continuity of care. The majority were as unaware as I had been, and were as shocked.. One, with an invalid wife, got angry, and started hammering the table demanding that GPs should return to their traditional responsibility for 24/7 care. He complimented me on my stroppy stance towards the medical profession, admitting that he didn't have the courage to answer back.
    That is what one group of patients thinks. Because of our age, we are a core group of NHS customers, and were not any old group of dribbling geriatrics. One was a high court judge.

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  • People demanding 24/7 are obviously oblivious to the fact
    or care not to listen to what was happening to 24/7 care
    Pre 2004.
    It was unsustainable due to demands of trivia at night (mixed in with real need )added to the vast increase in
    day time demands... It is worse now
    Humans can not do this safely!
    There is a system in place now that in general
    Means doctors working at night are then not
    Working during the day!
    How can that be so wrong?
    Patients want their doc who they see in the day
    to be available to them at night!
    How is that possible!

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  • The GPC seem to be proposing a common-sensible approach to OOH care - which means that HMG are likely to ignore it completely! Not enough sound-Bytes for them. People seem to have forgotten that practices were in effect driven out of providing OOH care - the criteria set following the Carson report into OOH provision set standards of response to calls which were just not achievable by small practices. That and the ever -increasing ooh demand by patients [ partly the result of HMG- fuelled over-expectation] made it an absolutely no-brainer for us to continue.

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  • I have an even better solution, charge patients for all OOH care, standard fee payable say of £20 for all care emergency or non emergency whatever the point of access and continue providing free care from 6-6pm Monday to Friday. It's incredible how demand will shift to normal hours given an incentive.

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  • I am very disappointed at all the comments above. Are you all GPs? If you are, you should be ashamed of yourselves. Many patients do not have "common sense" because there is no collective memory about minor illness. Confidence in their own judgement is at an all time low. Sure, there are those who are just lazy, but most are from people who are seriously worried. A help line (111) is just that, to reassure people that they can wait and there is nothing seriously wrong. Public Health campaigns and information need to be much more ballsy to be effective.
    Come on now, it's patients who pay you, stop saying it's all their fault!

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  • As a Patient Leader or trying to be i am shocked by some of the comments, posted here.Lets be honest there is no real patient involvement most PPGs are very small, made up of the same type of people and very rarely include anyone under the age of 60.They are also a happy hunting ground of ex NHS staff. If you buy a car you are given a service plan and warning lights on the dash board but to humans we just let them run until they drop. We must reach out and inform the public better on how to manage their health to reduce attendance at the GP's.

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  • Chaand's idea seems a very logical, positive and patient centred one. It's so confusing at the moment advising friends and relatives where to go for out of hours care no wonder most patients get confused. Developing a partnership of openness and trust with patients helps to avoid many of the horror stories listed above.

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  • GPs are "responsible" for everything it seems but the public are "responsible" for nothing. This is transactional analysis at its simplest ie Parent/Child mode. We need to move to Adult/Adult mode....

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  • Which is exactly what East of England Ambulance Trust have done! We have successfully merged 111/OOH/999 services together by tweeking the various systems to ensure compatability. We also talk to each other and have the same common goal, it is my sincere opinion that this integrated model is the only way unscheduled care can succeed. However; GP's will still need to re-engage with OOH care, which is difficult to forsee given the sheer demand being placed upon them in day-time surgery work. Patient safety dictates that OOH in particular is a GP led service. That said the DoH needs to recognise that one of the key issues dominating unscheduled care provision is Patient Demand Vs Patient Clinical Need.

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  • Just because I went to school it doesn't allow me the right to demand of the teaching profession what is not possible. PPGs are vaguely similar- been to see the GP now fully understand the pressure and can demand things. The Secretary of State is the same, if not worse as he supports homeopathy!
    The non medic commentators on this site need to read between the lines, if it's not already obvious, the DH undervalues us, the public demand too much, we can give very little more without breaking and despite this we are still more trusted than most.
    Dear public, listen to the professionals before it's too late. Dr Finlay is dead, so is 24/7/365 own GP, we're tired of working 50+ hours, tired of 40+ patients a day, tired of paperwork, tired of targets getting in the way of care, tired of attacks on investment in primary care, tired of pension and cointract reforms and tired of successive governments, media and public 'do-gooders' not understanding the real pressures and demanding health checks, appointments now and tomorrow etc... I could go on but I'm tired.

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  • @ Anonymous | 20 July 2013 1:35am: "If you ask a 3 year old what he wanted, and bought him all he wanted every day, guess how long your money will last? Do you tell your child he cannot have everything he wants and you'll only buy him things which you feel is right for him?" - That is the exact opposite environment David Cameron, George Osborne and Jeremy Hunt grew up in: where they can have whatever they want, at whatever the cost, even if they believe everyone else 'deserves' to live their lives otherwise!!! Ask a banker how much money he wants - tell the NHS how much money they deserve!

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  • I'm tired of working more than 50hrs a week too. I'm tired of ever increasing demands for me to do more work for less money. I'm tired that my customers demand better quality and more services. Unlike GPs I don't work in a monopoly provider, and I am not gauranteed both capitation and fee for service payments. My customers can and will go elsewhere. Nor will I get a publicly funded NHS pension as a result of working in a private profit-sharing partnership. You guys don't have it so bad. Stop complaining.

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  • 12.29
    Re-train and come and find out.
    GPs over-contributed by 400m to the pension pot to what ex-GPs took out. The public pension is not something you can 'bash' us with. Neither is 'service fees.'
    We'll complain until we can safely practice medicine again- it isn't a service industry. Capitalism in medicine has failed already but the government are driving ahead to introduce more. I will not balk at charging properly, done it for less than £5 take home per consultation for too long. Ignorance of the issues and figures is bliss to many.

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  • @ 12.29 - you are showing your ignorance of primary care medical services in today's NHS.
    Firstly we are not a monopoly - patients (customers) are free to move to any other local GP practice, or to go private. There is no obligation here whatsoever.
    Secondly, GPs try to provide good health care with limited resources (staff, time, money) but are increasingly having to jump through politically inspired hoops with no evidence of actual health care benefit - this is acknowledged to be a complete waste of our time as health care professionals, and is no value to the public. I'm pretty sure that other more "for profit" businesses can and do jettison inefficient (unprofitable) activities/products; we are hang-stung by politicians!
    Lastly, our NHS pension is not publicly funded - we pay both employee and employer contributions now, out of practice funding, and levels of payments are becoming so onerous that many of us are beginning to look at alternatives.
    The final point is that this article presents a possible pragmatic way forward for health care (Out Of Hours) and the comments here have highlighted some of the difficulties which are about how to provide an apparently open ended demand led service with finite resources; the medical view is generally the most sick and ill patients should get priority, those with relatively insignificant, self limiting illness should wait, preferably until normal day-time hours and consult appropriately (including getting self help and advice from your friendly local Chemist).
    Everyone is entitled to their opinion but not everyone can get what they want - hopefully an integrated OOH service will provide what they need.

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  • In 2004 the Labour Government said we could opt out of OOH if we forfeited £6600 per year. This equates for a 12 hour OOH shift for 365/1year to £1.50/hour. This just 25% of the hourly rate for Minimum Rate Pay!
    Do you know any other profession who would except these rates?

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  • Martin, don't forget Saturday and Sundays.

    In the case of a single handed practitioner 5 x 12 hours +48 for the weekend.
    5616 hours a year for £6600.

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  • I wish you had like button so that i don't need to write anything.
    Consolidation and rationalisation of OOH : Yes
    Fragmentation, Blame game, Duplication: No

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  • Sorry Anonymous10:52pm - it works out to £1.18/hour!

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