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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)

  • 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?

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  • @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.

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  • 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.

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  • 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!

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  • 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.

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  • 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.....

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  • 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

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  • 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.

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  • 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.

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  • 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.

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