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Independents' Day

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)

  • 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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