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Seven in ten GPs would not take back out-of-hours 'at any price'

Exclusive Most GPs would not take back responsibility for out-of-hours care even if they were offered up to £20,000 per partner and had a guarantee they would not have to do the on-call shifts themselves, a Pulse survey reveals.

The survey of 400 GPs reveals the extent of the opposition in the profession to resuming any kind of responsibility for out-of-hours care, with 62% saying they would support the GPC in taking some form of industrial action if NHS England seeks to change the GP contract to do this.

The survey also found considerable opposition to RCGP proposals that the profession considers taking back responsibility for the out-of-hours care for the 5% of vulnerable patients on their lists – with 87% opposed to the idea.

Half of GPs said they would still reject taking back responsibility for overseeing the quality of OOH care for their patients, even if there was a guarantee they did not have to do on-call shifts themselves – 36% were in favour.

Some 69% of GPs said they would not take back responsibility for out-of-hours care ‘at any price’, although 23% said they would do so for £20,000 per partner annually and 5% said it would take £10,000 annually for them to change their minds.

The strength of the opposition is likely to prove problematic for the GPC, who have recently been hinting that they may agree to co-operatives of GPs resuming out-of-hours responsibility for patients.

The GPC recently dropped its opposition to RCGP proposals for GPs to resume responsibility for the 24/7 care of elderly patients or those with complex medical problems, after the college clarified the proposal would be for GPs working in federations or co-operatives to take collective responsibility.

The furore over out-of-hours care was sparked by health secretary Jeremy Hunt last month when he announced that he wanted GPs to be individually responsible for their patients around the clock and given a duty to ‘sign off’ out-of-hours care.

LMC leaders last month rejected the possibility of GPs taking personal responsibility for out-of-hours care at their annual conference, and grassroots GPs taking the Pulse survey went further, saying any kind of extra responsibility should be rejected.

Dr Mark Beecham, a GP in Maldon, Essex said: ‘Definitely not. It would be the thin end of the wedge.’

Another respondent Dr Thomas Bloch, a GP in Broadway, Worcestershire said this would mean practitioners getting the blame for problems: ‘This would be a recipe for disaster - we would get the blame for any shortcomings. This is the only reason the Government wants to be shot of it.”

Responding to the survey, Dr Mary Church, a GP in Blantyre, south Lanarkshire said: ‘This is an over my dead body issue.’

Dr Richard Vautrey, GPC deputy chair, said the survey showed that contractural changes were not required as CCGs now had responsibility for out-of-hours care.

He said: ‘GPs are fearful that this would place a contractual change upon their shoulders and those who say it´s the thin end of the wedge are right.

‘We need to be very careful about any attempt to increase the weight of responsibility on GPs and we don´t want to complicate commissioning arrangements via CCGs by doing so at a time when CCGs are just getting started.’

Dr Vautrey also said that ‘no-one is threatening’ industrial action. However, he added: ‘If the Government is mad enough to go down that road, industrial action would be the least of their worries. GPs would vote with their feet and leave the profession and then you´d have a crisis in in-hours care as well.’

In full: Results of GP survey on out-of-hours care 

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  • out of hours september 08   3  N

Readers' comments (34)

  • Can anyone offer some advice for a hospital trainee who has just signed up to vocational training and is now seriously regretting it?? :( :(

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  • Vinci Ho

    Separate the training from your future job, mate.I do believe the the GP vocational training is well established in this country although there is on going controversy about RCGP examination which is unfortunately your final test before you can practise general practice . (In my time , 19 years ago , you do not need MRCGP to practise).
    Problem is government after government would like to mess with GPs for their political gain . I do believe GPs are 'people's doctors' and hence politicians will never leave us alone whether in primary or secondary care.
    Of course , you can go abroad after the training . Try to learn how different health systems work in different countries . They all have advantages and disadvantages .
    It is all about give and take . You might have to give a lot more before you can take some back .Not like old farts like us , you should have more passion and energy . Use them wisely , young Padawan. May the force be with you. Practising benevolence is our prime responsibility and ultimate mission .......

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  • @the young trainee

    Leave now othewise you'll regret it.Stick to hospital medicine

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  • The Danish gps have offered resignations
    In numbers...
    This may be the best option
    Time to resign and go private and charge the NHS
    what it costs
    Any willing provider should mean we compete on
    Quality and convenience and cost
    The NHS can reemburse patients
    what they feel they want to this may be all
    Or part of what we charge .
    So service can still be "free"...
    If the Gov want it to be or patients go to
    a provider that may choose but may get
    Charged more than they get back.

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  • To the young trainee complete your training as it is valued around the world in countries which pay better if we go private in England which look likely there will be a renaissance in primary care for the profession and the consumer either way stick with it

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  • Anyone else find it quite interesting that a paper that appears not to be pro GP, employs a GP that is a private, i.e. Not a GMS GP as a columnist.

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  • Thanks for your comments for the young GP trainee to be. All the feedback is gratefully received, I worked in a hospital specialty previously, did core medical training and the MRCP.

    My reason for leaving and applying for GP is a wish to work with a wide variety for patients and a real mix of medical problems. I hope maybe I can become a GPwSI.

    Along with this a lot of things about hospital medicine feel like they are getting worse - its the same pressures that manifest in A&E and GP on an already understaffed system (too may patients for not enough resources, with expectations that often out strip what is possible), meaning that the NHS relies on the goodwill of its staff and their resilience to make sure patients are kept safe. I think things have gotten worse under this govt. I don't feel this "breakneck pace" medicine, always firefighting, is a sustainable way forward.

    I also am tired of living like a nomad moving all over my deanery having to travel from one training job to another on someone's whim. If I'd wanted to live like that, I'd have joined the Forces!

    I want to be able to settle somewhere, with my partner maybe start a family and take back more control of life and I think this seems more possible in GP... Or at least I thought that until this government decided to rape General Practice!!

    I really don't know how it will all pan out, but reading the lies spun by the daily mail etc and the hate it engenders in people really concerns me. No one does any branch of medicine to become rich (possibly exception of private cosmetic surgery?) - there are far easier ways to make money and I think you GPs are worth your weight in gold. You seem under-appreciate by most patients and are definitely under appreciated by your hospital colleagues because they don't see all of the people you actually keep out of hospital and a&e. You have to make big decisions on limited information and rely heavily on a high degree of clinical ability. Compare that to hospital, where anyone can (often mindlessly) order an FBC, chemical profile, TnT, ABG, ECG and CXR .... You deserve to have control of your lives, a sustainable job that you find rewarding, and renumeration that reflects the huge level of responsibility you take day by day. You DON'T deserve lies being spun to whip up the hatred of ungrateful members of society, pay being slashed, and more responsibility than is safe for patients being forced onto you. Sorry for the rant! I feel very strongly about this.

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  • You're about to step into quicksand.Good luck.

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  • Vinci Ho

    Young Padawan,
    That 's life. Not always fair . Any choices have advantages and disadvantages . Choose carefully and try not to regret cos life is short.There are many other things more important than just a 'job'.....
    For those who spread the evils , what goes around , what comes around ........
    Live long and prosper..........

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