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GP contract set to change as Hunt hands responsibility for out-of-hours care back to general practice

The GP contract is set to be rewritten as part of reforms to out-of-hours care which will see general practice handed back responsibility for the care of patients around the clock, health secretary Jeremy Hunt has revealed.

Speaking at a King’s Fund conference this afternoon, Mr Hunt said that GPs will not ‘personally’ have to be on call at all times but that they should have ‘sign-off’ to say they are happy with their patients’ care out of hours.

He did not explain exactly how this would be designed but in response to a question from Pulse, said that the GP contract would ‘need to change’. He also admitted that an expansion of the GP workforce would be necessary to achieve the reform.

Mr Hunt said in his speech: ‘We have allowed ourselves to lose sense of the family doctor - the GP being a champion of our health not just the gateway to the system.’

‘Things were by no means perfect before 2004. But it is clear now that in that year some changes were made to the GP contract which fatally undermined the personal link between GPs and their patients.’

‘Out-of-hours services are perhaps the prime example of where things have gone wrong.’

‘We have had teething problems with the new 111 service. They were not acceptable and we are sorting this out. But those problems have rightly focused public attention on the variable quality of out of hours GP services.’

‘No one is suggesting that GPs should go back to being personally on call during the evenings or weekends - they work hard, they have families and they need a life too. But should the quality of out of hours care for people on their list really have nothing to do with a GP?’

Answering questions afterwards, Mr Hunt said: ‘What I am suggesting in this speech is a change in that I do want GPs to sign off that they are happy with out-of-hours care.’

‘I think that the contract needs to change - but it is not all about the contract’.

Mr Hunt pledged to address the bureaucracy faced by GPs, and reduce ‘the number of biomedical boxes they tick when someone walks through their surgery door’.

‘With every target or process comes bureaucracy and paperwork. Updating different computer databases, chasing up test results or diagnoses or scanning in letters from hospitals. One GP practice I visited recently actually had a post called “head scanner” because of the volume of letters they receive, that have to be scanned in and linked to a patient’s medical record, a function that takes around 6 hours every day.’

Mr Hunt also confirmed plans for a new chief inspector of general practice, who he said would work ‘inside the CQC’ and would ‘help drive up standards of excellence in GP practices across the country through clear, open and robust assessments of how well each practice is serving its patients’.

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Readers' comments (49)

  • I cannot, as a GP, be legally responsible for some other GPs actions-it is simple nonsense-whether I have "signed off" or not. An how are we going to expand the GP workforce-I have an idea-let's threaten them or get the Daily Mail to write to all young trainees demanding they enter General Practice to face a lifetime of abuse.

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  • Seriously?

    I should finish my training in a few months time, and I think I am out of here, if this is where things are headed....nice to see the LMC conference voting for us, and suggesting we should not challenge this.

    Why should any of us stay? Australia sounds very attractive just now. The government knows we don't have the courage to strike or to actually do something other then tut, and they can get away with anything.

    It will be interesting to see how this will improve the recruitment crisis will do for Australia, anyway!

    I am absolutely livid about this.

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  • Hang on-we could start "waterboarding" GPs until they agree to anything. The CIA must have some equipment knocking around. I imagine Hunt's grinning face looking down on me as the water flows over my nose and mouth. Ok, Hunt you are "only following orders" and I am sure one day you will have "no recollection" of your behaviours but right now it all seems very scary

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  • If he says the work force needs to expand by more gps to carry out the work then he will need one more than he thought , I'm off after hearing this,early retirement definitely now .

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  • We HAVE to strike.

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  • It is time we move away from calling the relationship between GPs and the DoH a "contract". We are neither independent nor contractors.

    The fact that our terms and conditions can altered on any political whim is worse than anything the private sector faces and worse than being salaried.

    Many of us are told old to move on and too young to retire now. Those lucky enough to able to jump ship should do so now.

    Mark my words... 24 hour responsibility will come with a serious lack of funding meaning that it will be the GPs doing the calls at 3 am or facing further heavy personal pay cuts to sustain a service of out of hours convenience rather than genuine clinical need.

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  • I am a GP and work in an area where the OOH care is provided by a private provider who has already been found guilty of "Cooking the books" - and the truth is probably far worse than what has been reported in the media. As a GP what control do I have over a multi-national corporation that sees bottom line as the only target.

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  • He is trying to shift any blame away from his department towards GPs.

    If he is implying the GPs would have to sign off on any OOH contract and the government will fund it that would be okay, but we are all aware that he means that GPs will be given minimal funding to provide a service at a level that nobody can afford.

    I would do the same as him if I were a politician, unfortunately I have too many morals to be a politician.

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  • We either strike or have a group resignation; if GPs are still providing 90% of the NHS consults, then I suspect capitulation will come quickly.
    I assume Hunt's constituents have his number for contacting him 24/7 also, or at least he has a deputy that he has signed off as suitable?

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  • Once again the BMA has been completely useless at delivering the real facts to the media and public.

    We are told that 90% of GPs stopped providing out of hours once the 2004 gentleman's agreement (let's not call it a contract) was changed.

    The truth is that most GPs were already doing OOH shifts for their local cooperative if the option existed or did personal on calls before 2004.

    After 2004, funding and personal income was removed from GPs to commission services from profit (e.g Harmoni) or non-profit making organisations to provide the OOH GP cover.

    Many GPs were prepared to continue doing regular shifts after 2004. It was the Governments policy of under-funding OOH work that led to private and NHS organisations being unable to pay a market rate for unsociable hours. Like many GPs I decided I would rather be poorer than spend time away from my family or increase my stress levels for what I felt was poor remuneration.

    Patients should be told that the government simply wouldn't give contracts that allowed a decent amount to be paid for complex and risky GP work weekends and nights. THAT IS THE PRIMARY REASON WHY THERE AREN'T ENOUGH GPS WILLING TO DO THIS TYPE OF WORK.

    Those of thus that did the shifts will recall that we were dealing with increasingly tricky OOH decisions (eg for cancer patients or people with multiple chronic illness) without having medical records or the benefit of test results or access to investigations.

    This is not work I would recommend to any one who tired after a very long working week. More of us will be forced into working these shifts or have to leave practices as the paycut will be unsustainable.

    I predict mass GP burnout, broken marriages and poor relationships with our children... oh and I think some dangerous mistakes may occur out of fatigue too.

    Do I hear the echo of mass resignation getting louder??

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