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A faulty production line

BMA calls for practices to work together to extend GP access in blueprint on future of general practice

The BMA has proposed that networks of practices work together to offer extended access and more alternatives to face-to-face consultations, in its vision for the future of general practice published today.

The major policy paper calls for a radical shift in the resourcing of general practice, and backs the ‘named clinician’ idea promoted by the health secretary for all patients with long-term and complex needs.

It also calls for an extension of GP training to five years and a 10-year rolling programme to ensure all GP practices that require it have a ‘purpose-built surgery’.

The Developing General Practice: Providing Healthcare Solutions for the Future policy paper details the BMA’s argument for greater resources to be given to GPs in order to ease the ‘severe pressure’ practices find themselves under and gives a list of suggestions on the way forward.

It suggests that the arrangements under the extended access DES should become more flexible, so that networks of practices can work together to offer surgeries at different times.

The document says that ‘collaborating with other practices to provide extended hours surgeries at a range of different times across a community’ would enable this to happen.

It also suggests that GPs should offer ‘more alternatives to a face-to-face consultation when clinically appropriate, such as dedicated telephone and/or Skype surgeries’.

It comes after NHS England included extending GP access in its ‘call to action’ consultation on primary care and after the Government announced it would trial groups of practices opening from 8am to 8pm on weekdays and also opening at weekends.

The document also says that all patients with long-term and complex needs should be ‘jointly managed through an integrated team in line with a single care plan led by the most appropriate named clinician’. This echoes the plans set out by health secretary Jeremy Hunt, which will see individual clinicians - most likely GPs - overseeing the whole care provided to vulnerable elderly patient.

Pulse revealed last week that the GPC is set to agree to the named clinician plans in exchange for a removal of the bureaucratic elements of the QOF. The document sets out the GPC’s support for such plans, despite the opposition of many in the GP profession.

The BMA document states: ‘Patients with long-term and complex needs should be jointly managed through an integrated team in line with a single care plan led by the most appropriate named clinician. This would require a much greater alignment of incentives and funding streams between general practices and hospital and community service providers.’

To improve the recruitment and retention of GPs, it suggest ‘lengthening GP training to a fully-funded five years with a much greater proportion of time training based in general practice’.

The GPC urges improvements to urgent and out-of-hours primary care services, including a clinician-led first point of contact and the removal of the ‘compulsion’ for competitive tendering for out-of-hours care.

There should be greater sharing of GP records across the NHS, long-term incentives to expand GP partnerships and initiatives to support GP returners back to work in order to solve the current shortage of GPs.

GPC chair Dr Chaand Nagpaul said: ‘Our vision for general practice is a bold plan to address both the immediate pressures facing GPs and develop a long term strategy for patient care by improving coordination, integration and quality.’

‘We need to look at new ways of working that can help GPs play a central role in delivering care that is more efficient and responsive to the needs of patients who increasingly need services that are more personalised and closer to home.’

‘To make these ideas a reality general practice needs greater investment to enable an expansion of the GP workforce and to fund new and innovative ways of working. We must end the uncertainty about future funding which is holding back GPs from meeting short term challenges and setting long term goals that could be a solution to alleviate some of the pressure on the NHS as a whole.’

But Dr Peter Swinyard, chair of the Family Doctor Association, said that the extended access proposals would not prove popular among many GPs.

He said: ‘I know that the change will not be welcomed by many of my colleagues, and I think some people will say it’s a sell out and that it’s the Government agenda just being parroted by the BMA.

‘[But] things have become so tight in general practice at the moment that, especially smaller practices, are just not going to survive without working together with other people. It just isn’t viable anymore, and we have to start thinking differently about how we’re going to organise ourselves.’

Dr Grant Ingrams, a GP in Coventry, said that the extended access plans would harm the core role of general practice to provide continuity of care.

He said: ‘The evidence from this country, from studies elsewhere, is that what gives you the best healthcare is seeing a doctor you know. And you cannot do that, if I’m in a rota twenty other doctors, or sixty other doctors or whatever, you lose that.’

This article was altered on 07/11/13 at 22:22 to remove the suggestion that the BMA backed the health secretary’s call to extend GP hours.

Readers' comments (42)

  • Iv'e never been a BMA member as I believe that, like the BBC, it has always followed its own political agenda.

    This means I do not get to have the pleasure of resigning, but would love it, absolutely love it, if enough doctors stopped paying their dues and forced it out of existence. .

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  • How do we raise a vote of no confidence in the GPC to remove the current Government lackeys?

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  • I cancelled my membership earlier this week.
    The BMA represents a lot of doctors. Hospital doctors, military doctors, occupational health, salaried GPs, public health, sexual health etc etc.
    Even if every GP partner in the country resigns, it will still be a large and well funded organisation.
    Is it time for GPs to consider joining another trade union, or forming a completely new representative body?
    Any suggestions?

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  • I fail to see why I should help look after another practices pts whose a access is crap and continuity is rubbish , considering the other practice gets paid more per pt then mine, and why I would encourage my pts to be looked after by another practice, we have ooh already so what's the issue.
    This is ridiculous, patients already have free choice where to go for their care and all this does is take away choice from The public which the government , bma, which to do.

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  • membership cancelled 1 year ago after the debacle with pensions, CQC, revalidation, etc, etc, etc, etc....

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  • So is this co-op til eight and then OOH really sounds like continuity of care. own GP, co-op then OOH.

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  • Harry Longman

    The first error in the government's proposal and the BMA's pursuit of it is failure to understand demand. Yes, continuity is important and not just for a vulnerable older group. But registering a specific group will simply add bureaucracy, while spreading the same number of doctors over longer hours will reduce continuity overall. What evidence is there from actual demand that patients want more opening hours? Here's the opposite: heard from a practice yesterday that now they have very rapid access all day to their GPs, initially with a phone call, in normal hours, they have given up extended hours. Simply not enough demand, though they have increased continuity. They are in a commuter town. Hello Mr Cameron and hello Dr Porter.

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  • since when can "clinically appropriate skype consult" stand up in court if it goes wrong?

    More stress just for sake of electorate convenience!!/vote winning

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  • very easy to make flat comments against BMA. if you feel passionately, then come forward to lead BMA to make it functional! running away from the problem actually will enhance the problem. dont be runner but a fighter. we as doctors are the most ununited groups in anywhere of the world. govt taking this opportunity!

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  • Having to attend a consultation ensures that the need to consult is weighed up by the patient as there is a time cost .
    Making us available for skype consultations is not the way to go, as it will stoke up inappropriate demand. It is so easy to send an email.

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