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GPs go forth

NHS England to review RCGP proposals to take back out-of-hours care for vulnerable patients

NHS England will consider RCGP proposals for GPs to take back responsibility for the out-of-hours care of the 5% most vulnerable patients as part of its consultation on reforms to urgent care, Pulse has learnt.

The proposals for GPs to assume responsibility for 24/7 care for the elderly, those with complex medical problems and those needing palliative care or with mental health problems were not included in a recently announced public consultation on proposals for improving out-of-hours care services in England.

But the primary care lead at the body told Pulse that they were ‘interesting’ and that they would use them to inform their ideas on how to take forward Jeremy Hunt’s suggestion that ‘the buck’ should stop with GPs out of hours.

The GPC was intially enraged by the RCGP proposals, but this opposition was later moderated somewhat after the college subsequently clarified that it would like to see federations and co-operatives of GPs and other healthcare professionals providing the care.

Dr David Geddes, NHS England’s head of primary care commissioning, said its consultation document is only a ‘first stab’ at solving the issue, meaning the RCGP proposals would also be considered.

He said: ‘The RCGP is an important resource that we have and we don’t need [the proposal] to be published within the documentation. We work very closely with RCGP actually on how we will progress with thoughts. It is interesting information and evidence and we need to use that to inform the plan.’

Dr Geddes added that said the remit for 24/7 care could be included as soon as next year’s GP contract despite the consultation running into next year.

He says: ‘Discussions really need to be happening with the profession and within NHS England in order to understand what the priorities are, and what we can deliver. They are going to be quite sensitive to discussions.

‘We know there are a lot of concerns for the workforce of the profession so it is not something that we want to be taking unilateral action on.’

But out-of-hours experts said that NHS England was concentrating on the wrong things.

Rick Stern, chief executive of the NHS Alliance and a director of the Primary Care Foundation, which benchmarks out-of-hours services, said:  ‘There is a balance to strike because certainly continuity of care is something we all want as patients and what most GPs want to provide.’

He said many of the ideas presented so far are hard to see working in practice, but the solution may come from better use of technology, rather than GPs returning to 24-hour responsibility.

He explains the need to develop systems ‘whereby whoever may be dealing with the patient in the middle of the night can access the best possible information.

‘I don’t think anyone is seriously suggesting that all GPs should be on call all the time for their patients. We need doctors who work sensible hours and therefore are able to make decent decisions.’



Readers' comments (24)

  • The RCGP is out on a limb here. This does NOT have the support of the profession.

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  • @above:its irrelevant that it doesn't have the support of the rest of the profession.OOH is going to be thrust down our throats whether we like it or not.The question is what're we gonna do about it?

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  • I wouldn't disagree with you, but it's particularly galling that RCGP is complicit in this. Whilst the BMA hasn't *achieved* anything, atleast they are making the right noises. It's shameful that this suggestion actually originated from RCGP.

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  • I am thinking about stopping my subs to both the RCGP and BMA, and stop the " voluntary levie" to our LMC. I feel misrepresented by GP`s unlikely to be affected by the proposed Changes for long. On call is on call, and in rural areas it is more often. Being half awake/anxious/available for a phonecall all night long, will affect our judgement the following day however they do it. Being available on a 1 in 4 for 24 hrs for 5 % of my patients and then Being tired for 50 patients the following is a great step back.
    Quoting a famous movie character- the needs of the many outweigh the needs of the few.

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  • Thanks a lot prof Gerada. We will nt remember you for the sensible stance you took in earlier art of your chair, but rather as the RCGP chair that sold the profession off to the government and condemning general practice to many years of overwork, recruitment crisis, and rising indemnity fees.

    I hope you are happy as rest of your members are not.

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  • How is this any different to covering 24/7?
    Crazy ill thought through.
    The problem we now have is work load
    Consultation rates have soared demands increased
    Who has the energy and mental capacity
    To offer any cover 24/7 particularly the 5%(to start!)
    Out of touch

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  • I've long realised that there is only one group of people that I trust less than the DOH and that is other doctors. The worst abuse and bullying that I have suffered has been at the hands of so those higher up the food chain. This hierarchal bullying is institutionalised and some colleagues would sadly sell their granny if it let them off the hook

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  • read what we are suggesting
    We ARE NOT suggesting that GPs go back to delivering 24 hours care - but, if we get more GPs then, GPs can work with others (including nurses, pharmacists etc) to help deliver care to those of our patients who are most vulnerable or at the end of their lives - this does not mean its the GP having to do the night calls etc - but being part of the system. A bit like having palliative care teams
    Please read what is said in 2022 - and dont jump to conclusions - but we also have to move our profession on to what patients need - and our vulnerable patients need continuity of care and reduced fragmentation.

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  • Dear Clare,

    Why do RCGP come up with these ill thought off proposals to appease Government without consulting GPs?

    Why cant Government improve current OOH services rather than this Drama of 5 percent vulnerable patients that GP Nannies are supposed to look after 24/7

    Be practical we are not running Somalian Charity camps here ,

    Decision support what ?? call at 3 am I am paramedic number 32 and have this elderly demented Jo Bloggs from X surgery you have never met and would like to see if you would like to admit hi or keep him in your garage so your wife can nurse him overnight ???what the fuck why cant OOH service with good IT support and link to patient medical records can take care of them.?/

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  • To Hasan Habib:

    Well said! Couldn't agree more. Either you are on all for the 5% of your own patients( no mention of the criteria to get on this list) or you hand over OOH care for others to do.

    Being on call is being on call whether it is for 5% or 100% of punters! What is the difference Prof between a future OOH doctor advising about how to care for a caller on the 5% list and an OOH doctor receiving the same call tonight?

    Answer= nothing whatsoever!

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