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A faulty production line

Hunt sets out plans to 'rethink' primary care as BMA demands urgent talks over out-of-hours attack

The health secretary has announced a new initiative to ‘rethink the role of primary care’ and remodel it to prevent emergency admissions and A&E attendances in patients with long term conditions, with a number of local ‘pioneer sites’ due to be announced shortly.

It comes as the BMA called for urgent talks with Jeremy Hunt over claims that the 2004 GP contract was ‘disastrous’ for the NHS and was to blame for high attendance at A&E departments.

In a speech this afternoon, Jeremy Hunt has said that primary care must return to its ‘root purpose’ of looking after patients in the community and ensuring they don’t become ill, rather than ‘simply acting as a gateway’ to hospitals. Click here to read the full speech.

He said that plans would soon be announced for ‘local pioneer sites’ to lead the way on developing this model of care, with GPs actively supporting patients to manage their health.

Mr Hunt used today’s speech to reiterate that ‘inaccessible primary care’ was to blame for the rising pressure on A&E departments, which he admitted was the ‘biggest operational challenge facing the NHS right now’.

He added that often patients were not being managed adequately by GPs, and this was contributing to rising levels of emergency admissions.

Speaking at an Age UK conference in London this afternoon, he said: ‘The challenge is to rethink the role of primary care, in particular its ability to prevent the need for emergency admissions.

‘Too often people with long term conditions are left to their own devices, without the help, care and guidance that local services should provide.

‘Then something goes wrong and they end up straight back in hospital needing emergency care, at great cost to themselves as well as to the system. Our primary care system has become reactive when it needs to be proactive.’

He added: ‘We need to return NHS primary care to its root purpose - looking after people in the community so they don’t become ill and need to go to hospital, rather than simply acting as a gateway to the system when they do.’

‘Norman Lamb will be announcing shortly plans for local pioneer sites to lead the way on this. I have also asked NHS England to look at the system-wide operational incentives that need to change to make this happen.’

The speech comes as the Department of Health said that it had asked NHS England to review out-of-hours care, and refused to rule out whether this would include considering whether GPs should take back responsibilty for out-of-hours care, as suggested in media reports.

NHS England’s deputy medical director Professor Steve Field also said today that GPs should ‘never have given up the responsibility for out of hours care’, adding to the debate over the pressures on emergency and urgent care services.

Dr Mark Porter, BMA chair, said: ‘The Government’s analysis of where responsibility lies for the huge and increasing pressure on emergency care is completely simplistic. Singling out individual parts of the health service and engaging in a blame game is unhelpful and misses the point.

‘Ministers should be engaging positively with healthcare professionals to improve and maintain services for patients, rather than demoralising NHS staff who are working harder than ever with fewer resources, wherever they are in the service.

‘GPs are undertaking increasing numbers of GP consultations and hospitals are facing similar levels of high demand that is only likely to rise in the years to come, and become more complex as the population grows and people live longer. These pressures are coming at the same time as health budgets contract in real terms.

‘The BMA has written to the Secretary of State asking for an urgent meeting so that we can discuss how we can move forward and tackle the latest emerging crisis facing the NHS.’ Click here to read the full letter.

 Dr Laurence Buckman, GPC chair, said: ‘The BMA has made it clear for many years that the provision of out-of-hours care in England needs to be improved, particularly in how it is resourced and co-ordinated, but it is wrong to blame the GP contract for problems with the system. The Government’s analysis of the problem is extremely inaccurate.

‘Out-of-hours care has historically been badly underfunded even before the introduction of the GP contract in 2004. Despite rising patient demand, funding has remained static in the last few years. The bungled introduction of NHS 111, which was intended to alleviate pressure on the system, has just made matters worse.’

Readers' comments (32)

  • it's thinking that got us in this mess in the first place

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  • Hunt is right, GPs should go back to looking after patients...ooops who will do the commissioning?

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  • Does he have any idea what GPs do? How can he suggest rethinking a service which you obviously has no understanding of whatsoever?

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  • Many NHS 111 providers are GP Out of Hours providers as well. They seem to be as successful as the Ambulance Trusts and others in running this service (or unsuccessful if you are in the wrong part of the country!). We need to grasp the concept of NHS 111 integrate it properly with OOH and re tender the failing services. Simply handing GPs their OOH commitments would be disastrous. We need to integrate, use technology and be patient centric and responsive in ways fit for this decade not the past fifty.

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  • I predict a mass exodus of over 55 GPs. At a time when I should have been able to look forward to a comfortable run into retirement, my income is ebbing away and the workload and pressures are escalating. I shall not be doing OOHs!

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  • Mr. Hunt, If your minions didn`t come up with ideas like the present 111 it would be lots better.

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  • This comment has been moderated

  • The department of health asks NHS England to review out of hours care......

    Under the reforms, NHSE's contract with the DH is already set out clearly in the mandate. The measures are to be outcomes.

    If NHSE say 'yes minister' it will be proof the reforms have done nothing to change the meddling role of the secretary of state despite all the legislation that espoused indepdence from politicians.

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  • A properly funded change to core practice hours, supported by changes in staffing practice, and part funded by reducing the hours to which 'out of hours' applies would be the best answer.
    8-8, all day saturday, part day sunday.
    No individual GP should have to work more than 5 days per week, but with sessional coverage spread between GPs, the services themselves should be available routinely more of the time.

    An end to the Monday rush would be an added bonus. Sadly the gesture politics of blame by the SoS is more likely to elicit a hostile response from most of the profession - but genuine good quality general practice is definitely part of the solution not the problem

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  • I'm intrigued to think how the above poster 5.07 believes as small practice of 20 GP sessions only per week spread between 4 doctors we can cover the hours he suggests without significant increase in costs. I currently only work 2 days per week and spend the rest of my time looking after 3 children. I would be happy to work mornings only for 4 days but the punters want the afternoons too, and the evening and the weekends etc, it just isnt possible for small practices

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  • I honestly can't believe this ill informed idiot is qualified to do a "rethink of primary care". With stooges like Prof Field looking for his knighthood chiming resonance with every coalition comment and a BMA showing stupid naivety and no balls still looking to "talk", the profession has no chance. The rethink will include GPs having OOHs imposed on us thanks to the disasterous 2004 contract ( the only point I agree on with Hunt by the way!). I give UK general practice no more than 3 years left to survive.

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