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RCGP chair challenges Hunt for using GPs as 'scapegoat' over A&E failings

The chair of the RCGP has issued a strongly worded statement saying there is ‘no evidence’ to support the health secretary’s claims that GPs are responsible for rising attendances at A&E departments.

RCGP chair Dr Clare Gerada, said GPs were being ‘used as a scapegoat’ and that it was not acceptable for Mr Hunt to claim that the rise in demand on A&E services was due to a reduction in out-of-hours provision by GPs.

She added that there was no evidence that the 2004 GP contract was as ‘disastrous’ as ministers have claimed recently, and pointed out that A&E attendance figures are calculated differently from a decade ago, throwing into doubt their claims that four million additional patients attended due to out-of-hours failings.

The unusual intervention from the college comes as BMA chair Dr Mark Porter called for urgent talks with Jeremy Hunt over his claims that ‘innaccessible primary care’ was to blame, saying he was ‘engaging in a blame game’ that was unhelpful and ‘misses the point’.

In a major policy speech yesterday, the health secretary announced plans 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.

Mr Hunt 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.  

He also reiterated his claim 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’.Click here to read the full speech.

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.

Dr Gerada questioned said: ‘Once again, GPs are being used as a scapegoat and it is not acceptable.

‘It is not true that the rise in demand on A&E services is due to a reduction in out-of-hours provision by GPs - and there is no evidence to prove that the increase is due to the GP contractual changes in 2004. We acknowledge that there has been a gradual rise in the numbers of patients attending A&E since 2004, but the numbers are calculated differently to a decade ago and now take into account attendance at walk-in centres and minor injury units.

‘There are numerous reasons why our colleagues working in A&E departments are under pressure. As well as a serious shortage of A&E consultants, the lack of co-ordination between health, community and social care -  particularly in the care of frail elderly patients - leads to a myriad of problems including unnecessary admissions, breaches in the four-hour target and delays in ambulance turnaround.

‘We must stop assuming that the health service starts and ends with hospitals.  Nor should we assume that increased demand equates to bad outcomes. Over the last decade, a number of initiatives have been put in place to  improve access to timely and appropriate care.

‘We are one NHS with patients accessing different services at different times - be it their GP surgery, walk-in clinics, pharmacy, NHS 111, or minor injury units, as well as hospitals. Focussing on A&E departments misses the bigger picture and does great disservice to the people working across the NHS who are trying to do their best for all their patients.

‘These are tough times for us all and one of the issues Mr Hunt should be addressing is the shortage of 10,000+ GPs across all services, not just out-of-hours.

‘As a national health service we should all be working together with Government to improve patient care, not blaming GPs for perceived ‘inadequacies’ in patient care.’

Related images

  • Dr Clare Gerada - online

Readers' comments (61)

  • "Mr Hunt said that primary care must return to its ‘root purpose’ "
    I would be happy with this. 25 years ago we were paid much the same as now without having to monitor asthma, BP, CVA, dementia, etc etc, No qof.
    The GP of the bygone era being invoked by Mr Hunt was purely reactive dealing with the patient's presenting problem, and if the GP could not cope with it the patient was sent to hospital who also did all the chronic disease management.
    That sounds nice!!

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  • Well said Clare Gerada! This just emphasizes the point that Jeremy Hunt does not understand or appreciate those of us that work extremely hard and under immense pressure in Primary Care.

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  • Once again Clare Gerada stands up for General Practice and Primary Care - thank you.
    In the end though, I fear it will be for nought. The government machine is too strong.
    I am sure this is an orchestrated campaign to end up with a salaried GP service that they think will produce better (by which I mean cheaper) primary care services.
    They'll miss us when we're gone and the fragmentation that's occurred means patients fall through the cracks and come to harm.

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  • Once again I would ask anyone reading this to sign my e-petition regarding Jeremy Hunt at:

    http://epetitions.direct.gov.uk/petitions/47740

    And please pass the message on - we cannot tolerate this fool for any longer!

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  • Ildiko Spelt

    Well said, Clare ! I am happy that you are out there for us. The profession is transformed in a ticking boxes exercise, while I have studied and I do love to treat patients and not papers. These days papers and tasks are piling up on my desk, there is no physical time to deal with them, so i just don't know what to do first...While my only priority should be the PATIENT.

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  • While there may be instances of individual GPs contributing to unnecessary A&E visits, I doubt that the problem is as widespread as Hunt insinuates. To make a blanket statement that GPs are the problem everywhere there is A&E overcrowding is very simplistic and ignores other issues such as changing demography and social behaviour, and reduced front-line funding for healthcare (for patients, GPs, and hospitals alike).

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  • Good to see that GPs' priority should be the 'PATIENT'.

    Back in the dark ages, my GP would visit my house to see a sick child at midnight. Then for a while their local 'co-operative' gave me access to a competent local GP (principal, probably) out of hours. This system disintegrated apparently when GPs no longer had to provide OOH cover, returning only a few pieces of silver to the Treasury for the privilege. Now I have a third rate system with a very poor local reputation that I would probably bypass for the equidistant A+E Department if only on the grounds that we could most likely communicate effectively.

    I have no wish to direct the blame for this very apparent and quite rotten reduction in NHS service to any group or body, but this PATIENT certainly does not feel prioritised by the current out-of-hours arrangements. Hopefully the RCGP is working on their improvement?

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  • Anonymous 10.33

    Why on earth should the taxpayer pay for a highly trained professional to go to see a sick child at midnighjt.

    The sick child should be brought to see the doctor! usually based near to the hospital. If it is an emergency then they should be in hospital. If its not an emergency then why are you calling at midnight

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  • Unfortunately the manner of Mr Hunt's Delivery isn't great (as always).
    I work in a busy city centre A&E department.
    There is NO DOUBT that there is a direct link between the 2004 contract and pressure on A&E departments.
    The quality and availability of OOH care is poor at best. 2 of our busiest days are now Saturday and Sunday with 30% primary care attendances.

    Patients and society expect a 24/7 available society not a cosy Monday to Friday 8-6 variety.

    The 2004 contract led to GP practice's losing ownership of their patients. I am not surprised that GP's signed the contract. I do however find it a shame that they won't have the decency to recognise the consequences.

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  • Clare,what you say is certainly true but its the wrong strategy to defend a politician's rhetoric with statistics.It makes you come across as being defensive,on the backfoot.Whenever you have a tussle between rhetoric that appeals to simplistic base human emotions and dry statistics the public will go for rhetoric.Hunt knows that the problem lies at the very structure of the NHS,ie.free at point of delivery and not enough tax revenue to meet patient demands.However he is not going to address that.Instead he appeals to the subliminal prejudice that GPs are the lazy overpaid fat cats of the medical profession and need to be tamed.Your problem is that you are too much of an idealist and consider the NHS as a paragon of all health systems.You need to fight him with rhetoric and not be afraid of criticising the inherent deficiencies of the NHS for which we are being made the scapegoats.Use the NHS as a lever to hit him.

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