Out-of-hours responsibility to be 'written into GP contract', claims top Conservative GP
Exclusive GPs are set for a radical rewrite of their contract to incorporate 24-hour responsibility for patients under plans being considered by the Department of Health, according to a leading Conservative GP.
Dr Paul Charlson, former chair and now head of policy for Conservative Health, told Pulse that based on numerous conversations in recent weeks with Government officials - including a special adviser to health secretary Jeremy Hunt - he expected responsibility for all-hours care to be added back into the GP contract.
But Dr Charlson, a GP in east Yorkshire who was a close adviser to the previous health secretary, Andrew Lansley, said the days of GPs being on call ‘have gone’ and said ministers were looking at whether the profession could ‘sell off’ or outsource this responsibility to out-of-hours co-operatives, but retain oversight.
His comments come amid a major political row over the pressure on A&E departments and intense speculation about an imminent shake-up of GP out-of-hours care. Mr Hunt, who on Sunday told the BBC’s Politics Show that ‘we need to go back to GPs having responsibility’, is due to deliver a key speech at the King’s Fund think-tank tomorrow, and according to a briefing released in advance will call for a return to the idea of the ‘family doctor’ so that patients know who is ultimately responsible for their care.
Speaking to Pulse, Dr Charlson said: ‘We are looking at what is going to happen with the new GP contract and particularly in terms of out of hours, how that might work and how that might play in, in the future.’
‘The details haven’t been worked out obviously as yet. Either the CCGs can make practices responsible for the budget, or you can have some contractual arrangement where there is a figure attached to out-of-hours care and GPs can either sell it off, if you like, or keep it. It depends whether you make it part of the contract or not, and that is the debate really.’
Asked whether Mr Hunt only wanted to put this out to debate, Dr Charlson said: ‘No, I think there is a feeling that it may be written into the contract.’
But he added: ‘I said to them, and I think they are well aware, that it is not going to go back to the previous thing of GPs getting up in the night, driving around the countryside, those days have gone. I think it will be much like the out-of-hours cooperatives.’
Dr Charlson’s comments come despite previous indications that some senior NHS figures would not support such a move. Speaking at Pulse Live earlier this month, NHS England chair Professor Malcolm Grant said he was not in favour of redrawing the contract for GPs to take back out-of-hours care
A DH spokesperson refused to comment, but said that further details about the health secretary’s plans would be released on Thursday.
GPC deputy chair Dr Richard Vautrey warned that changing the GP contract to give GP practices direct responsibility would ‘undermine’ CCGs.
He said: ‘We don’t think there is any need for any contractual change.’
‘CCGs have only been going for a few weeks and they have responsibility for commissioning out of hours and for organising services, and as GPs we are involved in CCGs. So that is the route through which we will improve out-of-hours services by bringing together community care, nursing care, A&E services, walk-in services and integration between them.’
‘That is the way to ensure out of hours and we have responsibility for that. There is not a real need for any contractual change that is totally meaningless. The Government has made huge efforts to put CCGs in place so it would be quite bizarre to undermine them, within seven weeks of them initiating.’
Medical defence experts also warned of ‘serious repercussions’ if plans for 24-hour responsiblity were pushed through without due consideration.
Dr Nick Clements, head of medical services for the Medical Protection Society, said: ‘A review is necessary and timely, but we are concerned that a new layer of regulation and inspection will result in an increased administrative burden, and by the suggestion of some sort of return to the unsustainable system of old, where doctors were working excessive hours as they struggled to maintain quality care around the clock.’
‘Government must listen to GPs and the rest of the profession, who are concerned for the safety and care of their patients.’
In evidence to the House of Commons Health Committee yesterday, NHS Confederation chief executive Mike Farrar raised doubts about the Government’s claims that the 2004 GP contract was responsible for the rising pressure on A&E departments.
He said in a later statement: ‘We do not see a correlation between the changes to the 2004 GP contract and the NHS four-hour waiting standard for A&E departments. In fact for the vast majority of the last decade, A&E waiting time standards have been improving. It is in recent years where the pressures have started to bite, and there have not been any discernable structural changes to out-of-hours GP contracts during that time.’
Also in Parliament yesterday, shadow health secretary Andy Burnham pressed Mr Hunt to present his evidence that plans to change the GP contract would reduce pressure on A&E departments.
Mr Hunt responded: ‘The changes the Labour Government made to the GP contract took responsibility for out-of-hours care away from GPs.’
‘Since those changes, 90% of GPs have opted out of providing out-of-hours care, and they got a pay rise in addition.’
‘We will address those problems inside A&Es and the system-wide issues. It is not all about the GP contract, but that is a significant part of it, because confidence in primary care alternatives is a key driver in decisions on whether to go to A&E.’