This site is intended for health professionals only

At the heart of general practice since 1960

GPs could provide 24-hour care for the frail and elderly, says RCGP chair

GPs practices could provide 24-hour care for frail and elderly patients both - in and out of hospital - if given additional funding, the chair of the RCGP has said.

RCGP chair Professor Clare Gerada told the London Assembly’s Health Committee that practices could be tasked with putting together ‘micro teams’ to free up time to deal with patients ‘proactively’.

Professor Gerada has recently been appointed as an appointed clinical chair for primary care transformation in London, charged with improving primary care services alongside London mayor Boris Johnson. She told Pulse that the role will see her tackle a range of ‘thorny’ issues - including the controversial question of whether GPs should retain their independent contractor status.

At a meeting discussing the rising pressures in London’s accident and emergency departments, Professor Gerada argued that investment in primary care-rather than propping up hospitals would help solve the crisis.

Professor Gerada said: [Given the funding] We can do a lot. There’s a whole series of things we can do better. One is we can improve continuity of care for those that require it, particularly the frail and elderly, we can risk stratify and find those patients.

‘I think we need to be providing 24 hour care for those patients in and out of hospital and in and out of hours. We can put together micro teams, to free up the time to deal with those patients proactively.’

She added: ‘We also need to be investing in and encouraging self-management for patients. There are a whole range of things that if we had the time we could use; e-templates, podcasts, we can start targeting those 29-year-old patients who don’t need to be in hospital.

‘We also need to be helping children. On a Monday afternoon A&E is almost like a playgroup, we need to be targeting those with better bespoke surgeries. At the moment we can’t do anything, at the moment we can barely get through a day’s work without being exhausted so that’s what we’d start to do given the money.’

Earlier this year, health secretary Jeremy Hunt said lack of capacity in general practice and out-of-hours services were to blame for rising A&E attendances and overburdened emergency departments, a view which the Labour leader Ed Miliband said he opposed at the party’s conference this week.

Readers' comments (25)

  • This is a very dangerous line to take with the government. There will be no new funding for such activity and there aren't enough doctors to take it on anyway. There frail elderly demographic is growing far to fast for them all to be risk stratified and proactively managed all the time, 24h care is just a pipe dream. 'Self management' just means no real care or reduced access. The real solution is to fund out of hours care appropriately and charge for unnecessary A+E attendance. GPs should charge for appointments like dentists do to cover the rapidly rising demand and the government should abandon all this internal market competition rubbish.

    Unsuitable or offensive? Report this comment

  • don't the leadership get it?

    no more talking ... it's time for walking !

    Unsuitable or offensive? Report this comment

  • This comment has been deleted by the moderator

    Unsuitable or offensive? Report this comment

  • Who/what determines frail?

    Unsuitable or offensive? Report this comment

  • at the moment we can barely get through a day’s work without being exhausted so that’s what we’d start to do given the money. Clare I have a few questions, how is throwing more money going to help? It does not make us less tired. What is your plan? are u expecting us to provide cover at the end of surgery for the frail/elderly? Why are u helping the government in its agenda to force OOH back onto us?

    Unsuitable or offensive? Report this comment

  • It is easy for Dr Gerada to make such comments while she herself works as a private Gp.

    Unsuitable or offensive? Report this comment

  • I'm sick of Clare Geralda. Soon to be reired from RCGP chair, soon to be London wide master of primary care, currently snuggling up to the government and abandoning those she is meant to represent in favour of expressing her own interest.

    Will BMA stand up and say she no longer represents our view (rememer the recent LMC vote?)? I doubt it and unfortunately this ambitious political GP has sold her profession yet again.

    Unsuitable or offensive? Report this comment

  • I would have thought the recruitment crisis meant even if there was more funding there would be no GPs to do the work. In which case why would the government put more money in - it does not make sense and appears to be just a plea for more money

    Unsuitable or offensive? Report this comment

  • It is SO DISSAPOINTING that she has come out with something so obviously stupid and designed to please the government. I thought she was better than this, but Like 'Prof' Field has decided to cosy up and hope that she will be on the New Years Honours list in due course. I feel like Beethoven did with Napoleon when he declared himself Emperor.

    Unsuitable or offensive? Report this comment

  • 5% of patients ( complex problems ) are 90 % of the work . = 90% of OOH . Will this mean 90 % of OOH funding = NO

    Unsuitable or offensive? Report this comment

  • "Micro -teams " so small they are invisible to the naked eye.

    Unsuitable or offensive? Report this comment

  • I thought Mr Hunt has already made it clear that ther is no new money for OOH work,other than that which will be saved by reduced admissions.The conlusion is obvious is it not?

    Unsuitable or offensive? Report this comment

  • She is already entitled to call herself Lady, so I do not think she is angling for an honour. I would just reiterate that we do not have enough GPs and we are unlikely to be able to recruit enough so piling more and more onerous duties on us is not the answer.

    We are now earning 25% less in real terms that we did in 2004. We are all working much harder. This is not sustainable. This government should be nurturing its' GPs not killing them with stress.

    Unsuitable or offensive? Report this comment

  • She is looking for work

    Unsuitable or offensive? Report this comment

  • Money alone will not solve this.... There would have
    To be a radical reduction in day work and a vast increase in staff numbers.
    No one will be expected to work over night
    then come in the next day .Hours worked in the evening will be compensated by later starts in the day
    Will need to recruit more staff to back fill.
    If she believes we will just do our day work then rota a cover doc
    She is misguided and out of touch.

    Unsuitable or offensive? Report this comment

  • I agree that the frail 5-10% of patient attract the most actual work - so the funding for OOH care should follow them.

    The healthy 90% 'should' attract a lot less work if someone has the will to tell them no when they call at 11pm on a Saturday for a repeat prescription.

    I suggest the frail 10% get NHS OOH care in exchange for the funding given to OOH, can be provided by current OOH provider or GP groups (i dont really care).

    The health 90% are told that they have to wait until they get an appointment on Monday. If they turn up at A+E then someone there needs to grow a spine (pair of ***) and tell them to go away.

    There will be an industry growth of private General Practice at Weekends/ evenings to cover the worried well/ well off and see people who value their work time more than the actual cost of seeing a GP at weekends.

    Can't see it being a vote winner though.

    Unsuitable or offensive? Report this comment

  • The patients have to go somewhere.If A/Es can't cope then they'll be shunted towards primary care.That's the way it is.

    Unsuitable or offensive? Report this comment

  • Dr Gerada - two simple questions for you. How many hours in 24 should a GP work, how many in a week. Similar question - how many patients should a GP see in a day, week ? Safely, that is, for patients and doctors.

    Unsuitable or offensive? Report this comment

  • Anon4.35
    If there is no capacity in primary care
    to cope ,does your argument also extend to this service?
    Or are you in the camp that GPs unlike any other
    Service have unlimited capacity and can work 24/7.

    We to like A and E are st breaking point.

    Unsuitable or offensive? Report this comment

  • @above
    GPs are portrayed as lazy,greedy and incompetent.The government's propaganda machine has made sure of that.In other words we're to blame for the NHS crisis not the super intelligent and hardworking hospital docs in A/e departments.So all is now left is to make them take on extra work and that is what unilaterally changing contracts is all about.

    Unsuitable or offensive? Report this comment

  • So how are you going to change the terms and conditions of all the salaried GPs that are employed by the Hurley group ensuring you provide enough manpower for the micro teams?

    Unsuitable or offensive? Report this comment

  • This comment has been deleted by the moderator

    Unsuitable or offensive? Report this comment

  • Well said Shaba. Where is this funding going to come from and the man power to do the 24 hr care for the elderly ? It will be suggested that the money will follow the patients and that even though there is an initial cash-flow problem, if GPs hit the road running and get organised..i.e, agree to take this extra onorous work for a pittance..the floodgates will open as soon as the recession ends and all will be handsomely rewarded. This ` waiting for the recession to end` would be like the ` With a view` offer in many practices, where the view eventually becomes just that of the back garden.

    Unsuitable or offensive? Report this comment

  • An extraordinary misjudgement from someone who the GPs trusted to present reality and actually tell it like it is. I would personally recommend that Clare Gerada, provide this cover everyday for one month in winter after working in a heaving NHS surgery and then have the courage to tell this Government the truth. Another person selling the profession for personal gain and power. As always ..recommendations that are good for others. Not for herself.

    Unsuitable or offensive? Report this comment

  • Please read what I am saying ! I am not saying GPs
    Should work harder - just differently and only if we get more resources
    Ps who says I am a private GP!!!
    I am an NHS GP
    I don't work 7 days per week but do 2 full clinical days per week as a mix of sick doctors, drug users and normal GP- soon to increase to 3 days
    I have worked as a GP for 25 yrs so please don't undermine my credentials

    Unsuitable or offensive? Report this comment

Have your say