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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)

  • 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.

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  • 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 ?

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

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  • 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.

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  • 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"

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  • 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.

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  • It costs on average £68 for every casualty contact. Who is going to refuse £40 for every OOH 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?

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  • 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?

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  • 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?

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  • 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

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