This site is intended for health professionals only

At the heart of general practice since 1960

GPs expected to provide 24/7 'decision support' under proposed out-of-hours revamp

GPs will have to be available 24/7 to offer ‘decision support’ in order to prevent patients from being admitted to hospital under a plan to radically reform the urgent care system published by NHS England today.

The move is proposed as part of a package of suggested measures to improve the care of patients seven days a week, including holding GP telephone consultations out-of-hours’ and a guarantee that patients can have ‘same-day access’ to GPs who are ‘integrated with their GP practice’.

The proposals are contained in a consultation on the future of urgent care, led by medical director Bruce Keogh, and published by NHS England today.

NHS chiefs said that they did not ‘necessarily’ want GPs to be on-call 24/7, but that they wanted to create a more ‘integrated’ system.

The document proposes that patients should be given ‘guaranteed same-day access to a primary care team that is integrated with their GP practice’, possibly through ‘GP telephone consultations both in and out-of-hours’.

It also proposes that GPs or out-of-hours teams should have ‘easy direct access’ to a same-day opinion from hospital specialists.

But what is likely to be one of the more controversial suggestions is to provide: ‘decision support from a patient’s own GP practice and hospital specialist nurse/team, seven days a week’.

Other suggestions to improve urgent care include having urgent care centres staffed with a ‘multi-disciplinary team with support of at least one GP or other registered medical practitioner’.

The proposals come after Pulse revealed that seven in ten GPs would not take back responsibility for out-of-hours care even if they were offered up to £20,000 per partner and had a guarantee they would not have to do the on-call shifts themselves.

The chair of the consultation process, Professor Keith Willett, NHS England’s director for acute episodes of care, told Pulse: ‘What we want to avoid is patients seeking urgent healthcare on the weekend or in the evening, and the person who is there not being able to access the medical information or advice that is critical to making the decisions, and therefore ultimately ends up in an avoidable transfer to hospital.

‘So what we’re talking about is not necessarily GPs being on 24-hour call, we’re talking about making sure the system is integrated. So that whether it is the out-of-hours GP, or whether it is the paramedic at the scene, or the GP seeing the patient at home that they can access the information they need, and that they can call on hospital specialist advice if that is all they need, rather than having to default to a transfer to hospital.’

He added: ‘Going back to the initial question of what is it like for the person who stands next to a patient with complex needs. Can they draw on advice from general practice, expert advice from the hospital, can they draw on the social services and directorate services that may contain the patient at home, with support.’

Asked whether NHS England would consider shifting more funding into general practice to support them doing more work out of hours, Professor Willett said: ‘The outcomes of the review are awaited and if that is what people think is the right thing to do then certainly all of those are possibilities.’

Following the consultation, which will be open to the public and NHS staff from 17 June to 11 August, the Urgent and Emergency Care Review will develop a national framework and associated guidance for CCGs in 2015/16.

BMA char Dr Mark Porter cautiously welcomed the review.

He said: ‘This review recognises the complex pressures on urgent care and as such is more likely to produce sustainable solutions. Spending on healthcare is squeezed, patient demand is rising and staffing levels are inadequate. The Government’s failed implementation of NHS 111 has only heaped more pressure onto an already stretched system.’

‘So far the Government’s response to this has been overly simplistic, with the blame being put squarely on individual parts of the health service.’

‘Emergency care providers are facing high levels of demand that are only going to increase in the years to come, and become more complex as the population grows and people live longer. We look forward to working with the review team to find a solution that enables NHS services to work together to provide the appropriate access to the care patients need.’

Related images

  • GP  on call 1 out of hours   Front  Neil O Connor

Readers' comments (50)

  • The Summary Care Record was shown to be an irrelelvance so what benefit will there be in direct links to practice records? It will still be the least qualified person making the vital decisions on the scene rather than traditional expert GP triage.

    Unsuitable or offensive? Report this comment

  • "GPs will have to be available 24/7 to offer ‘decision support’ out-of-hours "
    "NHS chiefs said that they did not ‘necessarily’ want GPs to be on-call 24/7"
    Don't these two statements contradict each other or am I missing something?

    Unsuitable or offensive? Report this comment

  • I do give my mobile numbers to all of my terminally ill patients with freedom to call me any time.
    If they have good package from GP, Matrons, and hospital staff, they rarely need anything from OOHs.
    Also if we have to take 24/7 responsibility, we need more budget, seeing patient at home need extra room with CQC- taps couch, infection control etc. I may have to be in suit and boot all the time. Also has to shave everyday :)
    Also all of the OOHs and Walking centres get millions of pounds from government, we get only few hundred thousands.
    They have to reduce their budget, and spread to local GPs.
    Most of the GPs are already providing week end services. But I don't want to see anybody with cough ,cold or diarrhea on week end. Or little discharge from post c/section wound. These things can wait.
    What if I am on holiday? What If I am watching movie in theatre with my kids, where we do get mobile coverage, but I have to keep feeling my mobile phone if it vibrates or not.
    Sometime patient go to OOH for their repeat scripts?
    Government should start educating patients as well.

    Unsuitable or offensive? Report this comment

  • Greedy partners who have already collected all the QOF moolah will now jump the ship

    Unsuitable or offensive? Report this comment

  • "...But I don't want to see anybody with cough ,cold or diarrhea on week end. Or little discharge from post c/section wound. These things can wait...". Sorry, you are hoping of no seeing the rule rather than the exception.

    Unsuitable or offensive? Report this comment

  • Its not the money "Anonymous" that will encourage chap(esses) like me to jump ship - and quite honestly the money hasn't been that great the last 3-4 years - it's the workload that will encourage full timers like me in their 50's working 6-7 days a week to want to join the great sea of locum/salaried and become "ladyboy" GPs doing their session and going home at a reasonable time to do what ever normal peolple do like enjoy family life or have a hobby like keeping fit or reading literature. This is the excuse a lot of us have been looking for to go a few years early and stop paying in to NHS pension scheme until we want to reture properly. Folk I feel sorry for are the younger group of prospective GPs, few UK trained Drs seem to want to be GPs anymore again - I wonder why

    Unsuitable or offensive? Report this comment

  • As an ex-PCT manager I'm almost glad I was made redundant (well, almost) - this system seems completely unworkable, presumably the brainchild of someone who hasn't got a clue. It's flawed, expensive and likely to cause more issues and lapses in care than the 111 rollout.

    Unsuitable or offensive? Report this comment

  • Er anyone remember the good old days of taking a hx from a patient?
    I don`t quite understand this- are they asking someoone from my practice to be able to answer the phone all night and advice that yes Mr Bloggs needs to go to hospital for his crushing central chest pain. or that no, mrs bloggs can`t manage at home because social services haven`t sorted out a carer and she can`t cope?
    If it`s integrating knowledge between ooh systems/ A&E then fine and dandy- but not really sure how much difference that will make to the patient in front of you. More Gp`s, and acute care teams with better social services is where the money needs to go.

    Unsuitable or offensive? Report this comment

  • So what is being proposed in a very sneaky way is that a GP from the practice has to be on standby to answer queries.If its a young infant then that's not something you can reliably do over the phone.So will you be saying "yes go ahead admit" or see the patient for yourself.You can call it whatever you want but its still OOH!

    Unsuitable or offensive? Report this comment

  • This reorganisation will not keep people out of hospital or control demand.Demand will just keep increasing in our current system

    Unsuitable or offensive? Report this comment

  • Is this not the current system but with primary care data sharing?

    Unsuitable or offensive? Report this comment

  • Looks like the return of OOH by the backdoor to me...

    Unsuitable or offensive? Report this comment

  • Hazel Drury

    Will be interesting to see the details of this and how it may affect us in the Wild West (aka Wales). Not about someone from each practice being on call to answer queries when I'm the only GP here! Single handers do still exist you know (despite Pulse never recognising us in surveys!)

    Unsuitable or offensive? Report this comment

  • I don't, in general, make decisions (or offer 'decision support') without having seen the patient. Unfashionable, but there you are. 'Decision Support' sounds very much to me like being on the end of a phone in order to take responsibility for clinical situations that we don't have enough knowledge of to comment. I'm not keen, frankly.

    Unsuitable or offensive? Report this comment

  • Let common sense prevail

    Spot on Dr Peverley, as usual. For 'must be available for decision support' read 'will be passed the responsibility for every single OOH contact'. That means working 24/7 because as GP's we will want to see and examine that patient to ensure their safety and our continued licence to practice. Give up all semblance of a normal life, die young and miserable. I think that's a bit of a backward step!
    I can't wait for the 8 week 'consultation exercise' which this article suggests started today. So in 8 weeks they will be telling us that what they suggested today is what will now happen.

    Unsuitable or offensive? Report this comment

  • We no longer have personal lists, and if a doctor from a practice has to be on call for decision support, they may know no more than the clinicians seeing them. This sounds half baked to me. At 55 at the end of the year it sounds like time to go. Sad, I used to like the job very much.

    Unsuitable or offensive? Report this comment

  • Ill thought through
    Any good clinician can asses and decide
    If admission is required
    Demand and expectation has been raised by uncosted
    Political rhetoric .
    Confidence in gps is lower because of political
    Lead anti Gp rhetoric to win public opinion
    to force through rubbish health policies
    that don't work ...
    Having a Gp in every practice ready to feed back
    Clinical notes!
    Or phone triage?
    Mad mad mad
    Why not just set up a Gp triage centre in casualty ?
    One place all seem to want to go to ?

    Unsuitable or offensive? Report this comment

  • the last few months with regard to health policies has just been a joke. I think this is the icing on the cake. They literally want us to work 24/7 365 days a year after spending the last few months slagging off almost all nhs staff about how we are crap, lazy, and uncaring? I can think of two words in reply to this. The second one is off.

    Unsuitable or offensive? Report this comment

  • I'm one of 2 doctors in a small practice. I did 1 in 2s (168 hours a week) as a 27 year old. Dammed if I will do it as a 57 year old.
    If this is imposed - I'm out of it - and its nothing to do with money!

    Oh - and most of my patients really will miss me and my enormous experience.

    Unsuitable or offensive? Report this comment

  • I think this whole exercise is about passing the buck. The government wants to pass responsibility of OOH to GPs because they cannot sort it out themselves. Now their plan is for under qualified and cheaper clinicians to pass on responsibility for decision making to a GP. If I am ever forced to do this my answer 99% of the time will be take to A+E so that a clinician who has seen the patient can make the decision. I might make an exception for the palliative patients.

    Unsuitable or offensive? Report this comment

  • Surely every change of plan should be based on evidence. If they want this to go ahead it should be trialled in an area and only implemented if it shows the service is better and costs are manageable and the study has passed peer review etc.

    Why do we refuse to waste money on drugs which are not proven, but insist on wasting money on reorganisations that are equally unproven?

    Unsuitable or offensive? Report this comment

  • Oh Bryan Bryan Bryan..since when do politicians follow evidence base?Its all about implementing a populist agenda which says have access to your doctor 24/7 365..and no politician is going to lose votes for it.

    Unsuitable or offensive? Report this comment

  • In a way I would be glad if this were to happen as it would lead to me retiring at 50 and may well be the best thing ever for my long term health and sanity.
    Last one out turn off the lights. .

    Unsuitable or offensive? Report this comment

  • If general practice falls over because every GP over 50 retires, then what of all their plans for primary care ?

    Primary care will become much more costly. Who will pay ? Will it be the government or the patients ?

    Unsuitable or offensive? Report this comment

  • If this happens I'll be gone by April 2015, 5 years earlier than planned. Will look at alternative pastures abroad. Have worked abroad previously for 6 years so no fears there. The alternative is private GP/private OOH. The punters need to value us

    Unsuitable or offensive? Report this comment

  • In our 4 partner practice, one GP has already resigned, one will retire in the next year and one intends to resign if this goes ahead.
    Not sure about the 4 th.......

    Unsuitable or offensive? Report this comment

  • Guys , Guys, Guys
    The answer to the entire problem is simple
    £10 per A and E attendance - sorted!

    Unsuitable or offensive? Report this comment

  • My practice had 8 partners when I joined. Three left before they turned 60. Two of them in their early 50s. We noticed it is becoming harder to recruit additional partners as they retire early. Yet another redesign is not going to solve the problem, but my bet is it will make it worse....

    Unsuitable or offensive? Report this comment

  • Hilarious!!

    Unsuitable or offensive? Report this comment

  • The Department of Health must want general practice to collapse. What is their ulterior motive ? What will they gain if primary care goes into meltdown ?

    Anyone got any ideas ?

    Unsuitable or offensive? Report this comment

  • As long as there is a supply of young GPs entering the trade there will be no crisis.The local and regional VTS schemes are oversubscribed.I suspect that's the reason why all these threats of resignations or early retirement are falling on deaf ears.

    Unsuitable or offensive? Report this comment

  • In reply to anon 18th June 10.12am.
    As a patient, I also wonder what the hell's going on, particularly at my surgery. This is one reason why I've started looking at Pulse online.
    Up until a year ago there were 6 partners at my surgery and a fair number of associate GPs. It seemed to be thriving. The 2 senior partners have now retired and not been replaced. A couple of the others have been off sick and 2 associates 'moved on'.
    We are not privy to any useful info. and it's very worrying. Wassup Doc ?

    Unsuitable or offensive? Report this comment

  • anonymous 12:12pm.The ship is slowly sinking!

    Unsuitable or offensive? Report this comment

  • What happens if we can't remember the patient, or confuse them with another patient, or we've had a few drinks, or we're distracted by children, or we're driving, or fast asleep......The lawyers will have a field day.

    Unsuitable or offensive? Report this comment

  • Amazingly, patients become time critically ill and require hospital treatment, and their elderly spouses cannot provide acute nursing care.

    Emergency service: "Does your patient really need to be admitted"
    24hrGP: "Yes - because they are ill"

    Unsuitable or offensive? Report this comment

  • Will start as a sugar coated pill and then sugar coating will be removed like reduced extended hours funding etc etc. Good luck to Mr Hunt and Bruce Keogh for planning half cooked gooses (with different name but same responsibility) to excuse themselves of paying for full OOH regular GP care which obviously NHS cannot afford.And good luck as well as they will need a lot of new recruits.

    Unsuitable or offensive? Report this comment

  • It costs on average £68 for every casualty contact. Who is going to refuse £40 for every OOH 8..pm to midnight contact and the same at weekends and £70 midnight to six am with a ceiling on how much you can claim over 24 hours? It's sad but doctors are money driven. I used to do 12 consultations on average on a saturday morning. one consultation at night every three nights on call and two advice call/visits per evening one in four. Do the maths- can you resist it?

    Unsuitable or offensive? Report this comment

  • The above works out at roughly £2,500 a week amongst 4 doctors. i.e. £30,000 a year per doctor - and if you don't do it?

    Unsuitable or offensive? Report this comment

  • I feel that doctors SHOULD be responsible for their own patients out-of-hours. How can you prevent disastrous events like the one caused by the infamous Dr Ubani happening if the patient's own healthcare professional is unavailable? This NHS is regarded as being world-leading, but it suffers many failings, one of the main ones being that GPs just don't seem to be prepared to take responsibility for their patients. Perhaps it's a function of the 'blame culture' we live in?

    Unsuitable or offensive? Report this comment

  • This government, and others before, have completely lost the trust of GPs (if they ever had any!) by repeatedly imposing non-evidence based work (waste of time pandering to "wants" not needs") for no money earned (or they take away monies and demand extra work to pay it back), and the only thing that drives us to "go the extra mile" has been our vocation and love of the job.
    Unfortunately they configure the job to be increasingly "ball busting" and demoralising. Net result (in management speak) - the emotional bank account is well and truly overdrawn!
    They will do what they always do, look after themselves, and likewise we should do the same.
    We should make personal choices with our own personal circumstances paramount.
    In negotiations there is a concept of "BATNA" - best alternative to no agreement" - We should start doing the exercise now and investigate alternatives to what is increasingly looking like a "worse case scenario".
    Governments will reap what they sow with the NHS - so look after yourselves and your families. As someone has said previously, there are always choices.
    Good Luck, and Bon Voyage!
    There is no more

    Unsuitable or offensive? Report this comment

  • We care very much about what happens to our patients but we are exhausted with contract changes, QOF, CQC, DESs, LESs etc. I am a committed professional but I have a right to a family life as well. Perhaps Mr hunt could be on call 24/7 as well. Has anyone got his mobile number?
    PS . is it wrong to want to retire at 42?

    Unsuitable or offensive? Report this comment

  • @Ruth Capocci
    I wish people would stop harping on about how great the NHS is and that it is a world leader.It may be the best "health system ever" if you have never contributed a single penny towards it like most of my council estate patients but if you're a taxpayer you're badly let down by it.You will spend most of your working life paying into it and when the time comes for you to get something back you will find that the services just aren't there or very severely curtailed.Having worked in the States (at the Mayo in Rochester) i can tell you that the NHS is definitely NOT A WORLD LEADER.

    If the health service was operating in a free market environment then the services would have adapted to the needs of their clients but in that instance you have a direct linkage between supply and demand.You want more you pay more.In a socialist structure like the NHS the resources are just not there to meet the unfettered demands of the populace without bankrupting the country.My solution would be to firstly make the tax system transparent so that we know exactly how much is being payed towards the NHS and then to allow the taxpayer to opt out of it entitling them to offset any health insurance premiums against tax.For the rest of the population which is unemployable there should be a very limited emergency service only such as the one offered by the Medicaid programme in the States.

    Unsuitable or offensive? Report this comment

  • as one of the "steady stream of youg GPs" mentioned in an earlier comment, the crisis will still happen and so will the subsequent collapse (at least of the system as it is now). I know that i have no intention of ever seeking a partnership, why would you? I would rather have a smaller income but actually be able to spend time with my wife and children (and not be on call out of hours to answer ludicrous questions from a random doctor who cant make a decision). I know that most of my colleagues at the same stage feel the same. Money isnt everything.

    Unsuitable or offensive? Report this comment

  • Anon 12:56,

    Whilst I agree with your evaluation of the economics of the health system, I have disagree with your assessment of the position of NHS. If you worked in sates, surely you know of the gap between the rich and the poor and the devastation lack of money brings to one's health. And this further widens the poverty gap and vicious cycle of poverty-ill health. I applaud the NHS in it's principle - it provides care to all, regardless of their financial position.

    But you are right - what would be deemed appropriate care has to be redefined and patient's demand & expectations properly managed by the DoH, rather than by individual clinicians. We simply cannot provide 24/7 everyone gets everything health care. But we should be able to provide majority of reasonable care at reasonably timely manner at reasonable cost - for which I believe primary care NHS is "world class". I know of no other country which manages this!

    Unsuitable or offensive? Report this comment

  • The issue is this - having just finished a 12 hour stint at your surgery are you now going to be rung for all the chest infections all night ? How many hours can we work ? Why are we expected to provide 24 hour cover ? I can work days or nights but not both.

    Unsuitable or offensive? Report this comment

  • Drachula

    Yes, I think I may have to resign and locum instead. I could go off abroad for a while and see what happens. Perhaps if enough of us do that then is there a chance the politicians realise what they are destroying? The trouble with OOH is that it simply extends opening hours. Many OOH doctors don't think they can send people away to go back to their GP, so they complete the episode and there is no education of the patient. The other problem is that A&E doctors and managers are too scared to refuse to see people, and send them back to more appropriate care at their GP or pharmacist. The fear of people's complaints is a big problem, and unfortunately, free services are not valued and are easily abused.
    Actually, some robust defence of GPs and senior A&E doctors so we can be backed up to tell people to go away, would really help the whole service. How about starting a public debate about what should actually be expected of A&E, and a deliberate extension of A&E waits for minors to 10 hours.....

    Unsuitable or offensive? Report this comment

  • The US health system appears to be designed to extract the maximum amount of money from people - it's now running at 16% of GDP, which is crippling America. NHS is a world leader.
    However, UK NHS is only a world leader because of the dedication of the people who work in the various parts - with Primary Care perhaps the most critical component.
    Sometimes it seems as though the current government is deliberately breaking NHS, so that those who can afford it have to go private (and if possible, those who don't pay taxes die and die quickly so they don't drain the system).
    We could change all of this. If we (NHS and independent providers including GP surgeries) start funding politician reelection campaigns and offering them directorships and advisory roles, they might take more interest in us? After all, that's what the US and South African companies do to UK politicians, and it seems to be working

    Unsuitable or offensive? Report this comment

  • Mr Hugo Minney.Like any good socialist/communist you seem to be under the great delusion that this country can afford a world class health care system for its entire population,free at the point of delivery, paid for by the taxpayer for ever.Even the Soviet Union had to abandon that la la dream and i strongly advise you should too.There will always be inequality in the population.That is natural law.Your solution is to rob Peter to pay Paul.I take the view that the taxpayer get's a poor return for what he puts in because he is too busy supporting others.If you're a taxpayer in the States your quality of heath care is superb.However if you're on welfare then you're in trouble.But you can't have it both ways.

    Unsuitable or offensive? Report this comment

  • Anonymous 10:59

    So are you happy with an 'I'm Alright Jack' healthcare service ?

    Personally we may be ok, but we are mothers and fathers and have parents. Pretty soon we will all know someone suffering with treatable illnesses, if they had plenty of money.

    Even if you have enough money now, what if you have an expensive illness or become old ?

    The NHS is the best system we have for general society, but it needs to be used responsibly and cherished for the precious resource that it is.

    It is not acceptable for dedicated professionals to be abused and treated like servants. Even if you do not care for doctors, self interest should make you treat them better. There is a global shortage of doctors and we have very portable skills.

    Unsuitable or offensive? Report this comment

  • Demand limitation is now vital.
    Charging for OOH - with a refund to be given only if the illness is judged 'serious' by the GP- would weed out the many current time-wasters.

    Unsuitable or offensive? Report this comment

Have your say