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)

  • 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

View results 10 results per page20 results per page50 results per page

Have your say