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GPs go forth

GPs urgently need better leadership on out-of-hours

The profession needs to unite around an alternative vision of how to improve out-of-hours care

If you are looking for a model case of how to turn a crisis into an opportunity, look no further than Jeremy Hunt’s response to warnings that A&E departments are on the verge of collapse. Whatever the rights and the wrongs of his analysis of the problem, he has successfully shaped a national debate that has as its starting point the assumption that GPs must take back some form of responsibility over  out-of-hours care.

With impressive political agility, Jeremy Hunt has effectively pre-empted the outcome of the NHS England consultation of urgent care;  as one national health journalist said to me this week, it is now a matter of how - and not if - the profession will take back out-of-hours responsibility in some shape or form.

 The very prospect is anathema for most GPs. A Pulse survey revealed earlier this month that most would not take back out-of-hours care ‘at any price’ - not even if there was a guarantee they would not have to do on-call shifts themselves.

NHS England has already responded to the health secretary’s call with a menu of options for improving out-of-hours care, most of which are at best unpalatable to GPs.

The response from GP leaders has so far been chaotic, with splits emerging at the highest level of the profession. The RCGP’s plan for GPs to take back 24/7 responsibility for the 5% of most vulnerable patients - immediately rejected by the GPC’s and hurredly clarified to no-one’s satisfaction - was clumsy to say the least. The resulting confusion must have been met with glee at the Department of Health.

Such divisions will only make it easier for a ‘solution’ to be imposed on GPs. So it is vital that the profession unites around an alternative vision of how to preserve better continuity of care out-of-hours, in an ever more fragmented NHS.

There can be no return to the days of being on-call and making clinical decisions on a few hours’ sleep.

Readers' comments (8)

  • The view from the coalface is that you cannot have a universal around the clock,free at point of delivery service,without input of a huge amount of resources.And its not only about OOH,you can also include the entire healthcare infrastructure for the elderly.So its upto the government.If its response is that "sorry there is no more money, you're already paid enough and if you don't follow through on our policy it will be imposed upon you" the end result will be a melt down of primary care because i can tell you alot of us are really fed up and ready to go.

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  • I'm loosing count of the number of people who are retiring, or planning to move abroad - both in Secondary and Primary Care. The brain drain will accelerate if we go to 24/7 responsibility/care.

    About the only things you could do to make it worse would be to attack pensions provision, remove proffesional satisfaction and replace it with pointless box ticking, threaten the independent contractor status of GPs, slash income and impose an external Stasi-like watchdog with no credibility of its own. Oh, hang on...

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  • What to do about Jeremy hunt !!where are the Taliban when you need them

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  • To accuse GPC of doing nothing is incorrect. Plenty of actions are in hand but we are not publicising plans until we are ready. Successful missions are 80% planning and 20% execution. Timing is all and a question of judgement in the context of up to date intelligence. Remember every one of your negotiators is a working GP suffering the same pressure that you all are. We NEED a solution just like all of you

    Peter Holden GPC Negotiator

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  • The "solution" to be promoted is to make use of the GP led organisations set up by this government to commision all services, i.e. CCGs and ask them to look at the quality of OOH care and access provided and invest additional resources to improve matters where needed. Simples.......

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  • You GPs are hopeless. You do not see an opportunity when Jeremy Hunt presents you with one on a plate. He wants you to take back oversight of OOH care. (I, an octogenarian patient with multiple comorbidities, who assumed that a GP was there to give continuity of care, am shocked that you gave it up in 2005.) So, now is your chance to agree with him wholeheartedly and tell him how many extra doctors will be needed to do it. Clare Gerada has said 10,000. OK. Go for it. JH has offered you an open goal.

    But all you do is whinge, threaten to resign, put up straw dolls about working 72 hours at a stretch. Have you never heard of rotas, like ambulance men, fire-fighters, emergency doctors? Playing the victim has become the default setting for GPs. Snap out of it. I, the patient. rely on you to help me navigate the choppy seas of the NHS. Do not abandon me, as you did in 2005.

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  • Well Richard, you show again considerable ignorance on how OOH is currently working .
    Most OOH provider hire local GP's ( mostly full time in hours doctors ) who do shift work on weekends , so we are already doing what you are proposing , but unlike before, it is left to the individual doctor wether they wish to do OOH or not. There is also serious implication for those that do , ie 50 % increase in your indemnity for seeing your patients after 1830 in the evening / more adverse event / complaints and claims against you because you are expose to more risks than those who puts their feet up on weekends, a bit like a driver who travels for a living pays more for their insurance becuase they are exposed to more accidents , but not because they are bad drivers necessarily. I'm sure you never worked 24/7 because you would never cope; so please do everyone in this forum a favour and get yourself educated on how the system really works before making anymore nonsense suggestions ..

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