This site is intended for health professionals only

At the heart of general practice since 1960

pul jul aug2020 cover 80x101px
Read the latest issue online

Independents' Day

Hunt: GPs to be held accountable for care round-the-clock as 'named clinicians'

Health secretary Jeremy Hunt has announced that older patients with complex health needs will be assigned a single ‘named clinician’ accountable for their care at all times when they are out of hospital, and has suggested this should be their GP.

Mr Hunt said that the move was intended to drive forward better-integrated, coordinated out-of-hospital care, ensuring ‘patients and relatives have a single point of information and responsibility for their care’.

But the announcement has been met with bemusement by GP leaders, who said that GPs already were responsible for their patients out of hospital.

The announcement marked the the 65th anniversary of the NHS and a major public consultation on a raft of new proposals to ‘refresh’ the NHS Mandate and improve the care of elderly people.

The proposals include developing new recommendations ‘to extend GP choice’, applying the ‘friends and family test’ to practices by the end of 2014 and improving access to primary care through the greater use of technology and ‘rapid walk-in access’.

But in a speech today, Mr Hunt chose to focus on a proposal to have a ‘single, named contact to coordinate an individual’s care’.

He explained: ‘We need to know that there is a clinician accountable for vulnerable older people in the community just as there is a consultant responsible for them in hospital.

‘As a member of the public I would like that to be my GP - but whoever it is they should be named so that patients, families and carers all know where the buck stops.’

NHS England will be asked to have named clinicians for elderly patients with complex health needs in place from April 2014, with the proposals a key plank of the new NHS Mandate for next year. Mr Hunt said that he hoped named clinicians would cover every patient in due course, although he did not offer a timescale for this expansion of the scheme.

The Department of Health said that they would seek views on their proposals to improve the care of older people over the summer and a plan would be produced to implement them with NHS England in the autumn.

A spokesperson said: ‘The final plan will be published in October and will be reflected in the refreshed mandate to NHS England for 2014 to 2015.’

Mr Hunt first floated the ‘named clinician’ proposals at a King’s Fund conference in May and the Government has earmarked £3.8 billion for better care integration and helping older people out of hospital in its recent spending review.

Speaking to Pulse, GPC chair Dr Laurence Buckman said he was ‘puzzled’ by the announcement as every patient already has a named GP.

‘He’s announced it repeatedly, we don’t know what it means. We’re going to be talking to Government officials to find out,’ Dr Buckman said.

‘Every patient already has a named GP. GPs are responsible – I don’t know what he thinks this means.’

RCGP chair Dr Clare Gerada said that the RCGP welcomed the emphasis on GPs’ central role in delivering care for the vulnerable, she had reservations about what the Government is really intending and where the money will be spent.

She said: ‘We’re terribly worried that this will mean £3.8 billion going into the private sector – that it will be a tendering process led by the corporate healthcare providers, the likes of Virgin who will set up integrated care organisations that will employ GPs but will be separate from general practice and will end up being money being siphoned away.’

‘Rather than that we think this should be directly invested in primary care. We have the best integrated care in the world – it’s called the general practice and multidisciplinary care team. If we build on that, if this £3.8 billion comes into primary care, we will deliver the best integrated services for our vulnerable elderly people as well as continue to provide care for everybody else.’

Related images

  • Jeremy Hunt - online
  • Jeremy Hunt - online

Readers' comments (85)

  • round the clokc responsibility.all my patients are elderly. nobody wants to work here. Im writing my resignation as we speak

    Unsuitable or offensive? Report this comment

  • A ridiculous and shocking idea. How can a single GP be on-call at all times for their nominated patients. This Health Secretary has the brains of an ant.

    Unsuitable or offensive? Report this comment

  • Community matrons were brought in to look after patients in the community who had complex needs! Patients do not need a named clinician as they already have a GP and a whole practice team set in place to look after their needs. Jeremy Hunt, you are a fool and a clown, you are dabbling with things that you have little knowledge of!

    Unsuitable or offensive? Report this comment

  • Where is the funding for this coming from? (presumably my bank account)

    Unsuitable or offensive? Report this comment

  • Half wit!

    Unsuitable or offensive? Report this comment

  • What the hell does it mean?
    My patients currently have a named clinician- Me.
    Does this mean i am accountable if I take holiday and one of my partners does`nt visit, orr ooh/community team gets it wrong. will I be on call 24 hrs.
    Fag packet idea with no evidence- so "Hunt" can get a soundbite.
    Earlier this week the consultants were targeted, prior to that the hospitals, and as ever we are constantly targeted. I feel like a pawn in a game.
    For god`s sake BMA/RCGp- get some response properly in the press, or please can the DOH/Mr Hunt let us know what the hell this will all mean in practical terms for the people at the coal face, rather than just making ridculous statements with no negotiation!

    Unsuitable or offensive? Report this comment

  • Does he realize the "buck" does not stop with the named consultant? He/She may be required to be responsible for the overall care but the trust is actually responsible for providing cover for consultant when he is on leave, organizing other clinicians/support staff/infrastructure to ensure an adequate care is given.

    Why does he think the trusts have chairs who over sees the trust? When was the last time we've seen a consultant held accountable for overall failure of the hospital - never!

    Unsuitable or offensive? Report this comment

  • This man underestimates the rage that he causes. I'd rather spend time locked in solitary confinement 18 hours per day than take round-the clock responsibility. No other medical speciality, bar none is expected to take this level of responsibility. I would not do this for a salary of £500,000 per year. I don't give a ****, I am not bloody well doing this and nobody, and I mean NOBODY is going to make me. Waterboarding could not change my mind......nothing and nobody-and that includes government stooges.

    Unsuitable or offensive? Report this comment

  • Mr Hunt's true nature is revealeled in these
    romantic untested theories .

    Unsuitable or offensive? Report this comment

  • I had a patient's daughter tell me yesterday that she was not prepared to be responsible / on call for her father's care 24 hours a day. Her mother is dead, so he is the only dependent she has.
    I have 395 elderly patients on my personal list, as well as a fair number of younger patients with very complex needs. If she can't/ won't do it for one, how on earth can I possibly do it for 395+?
    And she does not have to take the responsibility for rationing/ commissioning/ hospital standards/ practice standards/ financial hit.......

    Good thing I have already resigned.

    Unsuitable or offensive? Report this comment

  • THE BUCK STOPS WITH YOU MR HUNT-YOU ARE THE HEALTH SECRETARY NOT ME......THE CLUE IS IN THE TITLE. YOU ARE RESPONSIBLE AND WHEN THIS GOES WRONG,

    Unsuitable or offensive? Report this comment

  • This comment has been moderated.

  • There will be marches in the streets over this. I hereby demand that anybody who opposes Hunt agrees to march in London. Let's set a date. Come on you bunch of lemons. I am deadly serious. Banners with "Down with Hunt" and "Topple the Dictator Hunt". All the appeasement and grovelling that takes place in this country-get some cohones-and get on the streets!!

    Unsuitable or offensive? Report this comment

  • Sadly a march will not work. It will give the government and Daily Mail another opportunity to say we are selfish, lazy and thinking of ourselves rather than our patients.
    The public will love this idea. They will not understand that it is impossible and will start working out how to exercise their right to " choice" in who that named provider will be.

    The only way to make the point is to resign.

    Unsuitable or offensive? Report this comment

  • Forget the RCGP and BMA and similar.These disgraceful organisations need political summary dismissal-they have betrayed us and seek appeasement with the dictator Hunt. Forget the government stooge organisations too. Down with Hunt, down with the dictator!!

    Unsuitable or offensive? Report this comment

  • "...responsible for their care at all times when they are out of hospital"

    That does not mean accessible at all times.

    Everyone appreciates the strength of feeling about returning to person OOH responsbility, but stop letting sensationalist Pulse wind you up before the detail is out!!

    Unsuitable or offensive? Report this comment

  • Who defines complex needs and is this health needs, social needs, toileting needs or every bloody need.....

    Unsuitable or offensive? Report this comment

  • **** the Daily Mail ! I said I am not doing this and that means I am not doing this. I could not care less about the consequences, it is simply not possible to change my view on this, ever. And you lot need to be as determined as me. Some things in life are worth sacrifice and this is one of them.

    Unsuitable or offensive? Report this comment

  • Even if this simply means being " responsible" for these patients, it would cause disputes in practices between clinicians.
    In our practice I have 10 times as many elderly patients on my list as another partner, who does mainly family planning and antenatal. This would require a very large proportion of these patients to be reallocated against their will.
    I can see the headlines....." Patient forced to see GP he/she does not want by practice"

    Unsuitable or offensive? Report this comment

  • Accountable / responsible for a patient is not the same thing as personally delivering their care.

    CCGs have accountable officers, but surely no one here believes they personally deliver all of the care they are responsible for.

    GPs are responsible for patients in hours, but turn over management of those patients to call services during protected learning time.

    I can wholly understand the mistrust of Mr. Hunt and the likely slant that the media (especially the Daily Mail) will present regarding these proposals, but until more is known about the detail I can't see why there is so much knee-jerk reaction assuming that GPs will be required to deliver the care personally- nothing in the statement supports this.

    Unsuitable or offensive? Report this comment

  • Far too much heat in these comments. This will most probably just mean that these patients will be listed in a "virtual ward" with regular MDT-type discussions and an admission-avoidance plan. Many CCGs are working towards this already in any case. Being "responsible 24 hrs" means ensuring that plans etc are in place, and reviewing when something happens, it doesn't mean actually being available in person OOH.

    Unsuitable or offensive? Report this comment

  • Ok flip it make the patients responsible for understanding their care needs then set up a plan. You give this duty to already overworked areas with no thought to staff we are in the NHS to care who cares for the staff they will leave, stressed overworked and public opinion when it is presented in this way will not help. Who is the marshall in town? We need common sense clear thinking and communication plans first not shifting work loads measured against care plans alone. Give some plans to primary and secondary care see what we come up with theres the challenge back.

    Unsuitable or offensive? Report this comment

  • I think its time we all moved our bed into our surgeries so that patients can have access to us 24/7.17th of January cant come soon enough

    Unsuitable or offensive? Report this comment

  • Please please please can we not go down the pathway of care plans. Our district nurses spend more time writing meaningless trivial care plans than actually hands on caring for the patient

    Unsuitable or offensive? Report this comment

  • ANOTHER VOTE WINNER

    IF GP TAKE 24HR Control WHERE DOES THE European working hours directive come in to the thinking. Oh silly me we can veto that, it doesn't suit us. Hunt has lost the plot silly me he never had it!!!
    If doctors are the cause of the NHS woes, when are the MP going to realise that they are the real cause of our ills. No Idea, No sense, only interested in ripping off the electorate and more worried about the next election than common sense and responsible governing.
    RANT OVER

    Unsuitable or offensive? Report this comment

  • The man is clueless of what is talking about.

    Unsuitable or offensive? Report this comment

  • Surely this concept goes against the working time regulations and why hospital doctors and juniors are not aloud to work more than 48hrs per week. How is it then that the powers that be want GP's to be on call 24/7? they will still have to continue with their surgeries during the day!!

    Unsuitable or offensive? Report this comment

  • Thank God I am out of it, RETIRED

    Unsuitable or offensive? Report this comment

  • Why do many of us react so emotionally to this report? Obviously nobody is asking for a gp to be on call 24 hours a day 365 days a year. Most of us have opted out of OOH care & no longer have that responsibility. During in hours care it is not unreasonable for a gp who knows that patient to be responsible for their care personally.This essentially is an OOH problem. I am quite sure that you as an elderly patient would like the 'safety' of knowing you only had one contact point to go for care rather than have to fight the present OOH arrangements with unknown paramedics/nurses trying to eventually assess the situation.

    Unsuitable or offensive? Report this comment

  • EU working time directive would prohibit a GP being "available" 168 hours a week 52 weeks a year.

    Unsuitable or offensive? Report this comment

  • " in a move he said was a first step towards GPs taking on round-the-clock responsibility for all patients."

    Unsuitable or offensive? Report this comment

  • So am i going to be called in the middle of the night for faecal impaction?...and please i don't want to know that you have retired already because i get really depressed that i can't afford to do it yet.

    Unsuitable or offensive? Report this comment

  • i agree wiht most of what is being said , what do you expect when you get a minister that not so long ago had another portfolio and pretends to lead something like th NHS in whihc he is completely clueless . This proposal shows that he has no idea how the system works already , GP's are already responsible for all their patient out in community and what happens to them OOh is reported to them in the morning so they can act upon it if indicated . A name list has been mostly abolish wiht the introduction of surgery list or shared list ages ago. There are advantages and disadvantages in both scenarios. I completely fail to understands in what way his proposals are any different than what we do now .
    can somewhat please explain to me in what cliincal scenario an OOH doctor who beleives a patient needs to be admitted would take the advice of a drowsy GP at home who has not seen the patient telling him not to bother . The idea is entirely barminig , because one would erred on the side of caution and admit anyway , plus the visitng GP would have ultimate responsibility medico- legally im sure , not the one giving the advice..

    Unsuitable or offensive? Report this comment

  • There is no way ANY of this can be acheived without HUGE addtional funding AND reintegration of NHS services to the exclusion of private providers. The chances of that are less than none.

    It's just noise - my tip is to regard it as comedy noise and carry on regardless.

    Unsuitable or offensive? Report this comment

  • This comment has been moderated.

  • Its pretty much what Clare Gerada was suggesting

    Unsuitable or offensive? Report this comment

  • I can't believe the naivity of some GPs. Have they not heard of chief execs in several trusts stepping down recently? Why do you think they have? It's because they are responsible for the care their trust provides. No individual clinician takes this degree of responsibility now in NHS because no clinician will have time to fully control their service.

    So, whilst I have no personal control over our contract (secondary care trusts do), OOH provision (negotiated at CCG level) , care home standards (I'm not CQC), ambulance or social service, I'm expected to be personally responsible for it. At less than 1/3 of the chief exec's pay.

    Do you understand why we feel angry now?

    Unsuitable or offensive? Report this comment

  • In response to some posts reuqesting clarification of how this differs from the present.Surely Mr Hunt's aim is that the named clinician or a member of his or her practice will be the FIRST point of contact for this group of patients and not the out of hours service.This I would wager is what he means by responsibility.I sincerely hope this is not the case but I doubt it very much!.

    Unsuitable or offensive? Report this comment

  • I can't help but to laugh. I got made redundant as part of the reforms and not sure I can fully explain how glad I am to be out of some of this BS.

    Unsuitable or offensive? Report this comment

  • @Anonymous | 05 July 2013 12:10pm

    Yes that's what he is saying and note this is just the FIRST STEP.Otherwise just having a named clinician doesn't make any sense because patients already have that.It will mean us fielding inquiries during OOH from patients or other health care professionals.

    Unsuitable or offensive? Report this comment

  • I normally have great respect for Clare Gerada's views, but I couldn't believe that she suggested this nonsense in the first place. It was obvious that Mr Hunt would seize the opportunity to pile more work on GPs.

    Unsuitable or offensive? Report this comment

  • This comment has been moderated.

  • listen guys,it ain't going to happen because it is physically not possible to happen.just have a laugh and carry on doing whatever best way you can.

    Unsuitable or offensive? Report this comment

  • I'm more worried about the 'rapid walk in access' bit.
    A significant minority of patients already do this which really annoy those who have booked in appropriately.
    Fast food restaurants serve up crap.
    Can't wait to the return of sit and wait surgeries after a disturbed night/weekend.GMC/MDU/MPS will be doubling their staff in anticipation.

    Unsuitable or offensive? Report this comment

  • EU working time directive only applies to salaried GPs. Hunt has cleverly manouevred NHS GP partners into a corner with 24/7, 168 h work weeks to force a full salaried GP service on all GPs with fhe help of the BMA! DOI sit on the BMA sessional GP subcommittee and just read fhe BMA salaried GP service paper!

    Unsuitable or offensive? Report this comment

  • Does this mean he is prepared to make partners salaried ?

    Where do I sign ?

    Unsuitable or offensive? Report this comment

  • don't worry one and all we do very well usually when they impose ideas apon us without thinking them thru , look what happened when we flogged them OOH for 6k in the first place !

    Unsuitable or offensive? Report this comment

  • So at what point do we down tools and tell these politicians who obviously have no brains/ thinking faculties and just want to vocalise what they think the public want to hear so they can get reflected to take. A hike.. Problem is the bam and RCgp are manned by toothless bulldogs who are more interested in "not rocking the boat" than in fighting our cause & telling people the truth . The requirements of this govt with GPS is just unattainable --any wonder we are having recruitment issues..?
    These politicians have "doctor envy"

    Unsuitable or offensive? Report this comment

  • This comment has been moderated.

  • Vinci Ho

    Editor please keep this article on the top of the web page .
    I bet we can get 500 comments over the weekend.
    All comments are welcome
    Come on guys

    Unsuitable or offensive? Report this comment

  • IT IS TRUE THAT EWD ONLY APPLIES TO SALARIED POST , BUT I CAN ASSURE YOU , THAT IF PATNERS DARE MAKE A MISTAKE AND IT IS KNOWN THAT YOU WERE TIRED OR WORKED EXCESSIVELY, YOU ARE LIABLE ON CORPORATE MANSLAUGHTER CHARGE IN THE SAME WAY YOU WOULD BE FOR DRIVING WHILE HALF ASLEEP .

    Unsuitable or offensive? Report this comment

  • Many thanks for your comment Dr Ho - rest assured this will stay top of the site for a while as it's clearly generating a lot of comment...

    Steve Nowottny
    Editor, Pulse

    Unsuitable or offensive? Report this comment

  • @ Anon 2.26pm

    Its a Caps Lock button darling, learn to love it.

    Unsuitable or offensive? Report this comment

  • How to win friends ad influence GP's, By J Hunt!!!!

    Unsuitable or offensive? Report this comment

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

Have your say