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Labour policy review group to consider radical plan to ditch GPs' gatekeeper role

Exclusive GPs could have their ‘gatekeeper’ role removed and see patients given direct access to specialists, under radical plans being considered by the health and care policy commission set up by the Labour party.

The plans - submitted by trade union representatives to the Labour policy committee - would mean a ‘multidisciplinary team’ would take charge of an individual patient’s care, with the GP’s role scaled back.

In an exclusive interview with Pulse at the Labour Party conference in Brighton, Rachael Maskell, head of health at Unite, said the change was needed to move patients through pathways ‘much faster’ and ensure they get the services they need.

But the GPC warned that removing the responsibility for GPs to be patients’ advocate would ‘undermine general practice’ and ‘bankrupt the NHS’.

The plans come after Labour leader Ed Miliband promised to ‘save the NHS yet again’ if the party is elected as the next Government in 2015 and shadow health secretary Andy Burnham said that if Labour won the election, one of its first acts would be to repeal the coalition Government’s NHS reforms.

Ms Maskell is a member of the health and care policy commission, which is charged with setting the overall direction of health policy for the Labour party.

She told Pulse that Unite had submitted ideas to the commission looking at how ‘GPs can be GPs again’ and how Labour could empower the profession to do what it does best.

She said: ‘We are looking at access and think it is wrong that GPs are the gateways to the whole service. Because different specialisms are the expertise for that particular area of specialism. We don’t see why GPs always have to be the gatekeeper.’

She added: ‘[The policy] is looking other people in the [health] system and the possibility of getting direct access. At the moment, they have to pass an extra block in the system by seeing the GP which doesn’t free them up, it just clogs them up. It is very much about moving people through the pathways much faster and getting the services they need, from the practitioners they need… GPs being part of this multidisciplinary team but not the lead, necessarily. Because I think that is a model of the past.’

Ms Maskell said that the union wanted to restore the ‘clinical significance’ of GPs, but warned it could not guarantee any additional funding would be provided.

She said: ‘We are not talking about money going to GP in the future; it is talking about money going to the right place in the service. So as I said, GPs shouldn’t be the gatekeeper to the service, so it is not about money going direct to GPs. It is going into the service in the appropriate space.’

‘We have to be real, GPs aren’t the cheapest part of the service so there are other practitioners who are highly skilled, highly trained and advanced in their clinical skills, diagnostic skills, treatment skills and prescribing skills - and therefore we have other parts of the service which can actually lead those services and take them forward. It shouldn’t be a GP-led service.’

The ideas have been submitted by Unite to Labour’s health and care policy commission and will be reviewed ‘along with all other submissions as part of a democratic process’, said Ms Maskell.

But GPC deputy chair Dr Richard Vautrey said the union’s ideas would be completely unworkable and would cost more in the long run.

He said: ‘This would bankrupt the NHS and completely undermine general practice in the process. It is time politicians woke up to the massive benefit general practice and GPs as specialist generalists provide - it is the reason the NHS remains sustainable.’

A Labour party spokesperson said: ‘Labour’s policy review on integrated health and social care is looking at breaking the silo-mentality and moving away from a strictly medical model of commissioning.’

Asked to clarify whether that meant the party backed the Unite proposals, the spokesperson added: ‘It’s tough. It’s not being looked at in those terms, but the integrated care review will change that outlook - just in a much more fundamental way.’

Readers' comments (102)

  • We have to be real, GPs aren’t the cheapest part of the service so there are other practitioners who are highly skilled, highly trained and advanced in their clinical skills, diagnostic skills, treatment skills and prescribing skills

    Labour are welcome to follow this line of thought, but I suspect the policy people would be rather surprised that the cost of a single OPD appointment in hospital or even a urine dip in A+E costs more than a year of GP care. For all of its problems, GP is remarkably cost efficient.

    Unless, of course, these 'other practitioners' aren't Doctors at all....

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  • I agree, I think it depends, pts should be able to self refer to physio,occupational health, mental health services, dementia services via social workers, exercise classes, cardiac rehab , lung classes, dietician services, drugs and alcohol services , district nurse services, community services , speech and language , podiatrists, etc etc without having to go through gps at all.
    It's ridiculous that we have gps acting as bottlenecks to these services

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  • She is clearly suggesting a nurse run service from my interpretation. Nurses are rightly risk averse so in the absence of GP advice, I can only see this resulting in higher referral rates and costs.

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  • GPs have already de facto lost the gatekeeper role for emergency admissions (only a quarter and falling fast are now admitted by GPs).

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  • THIS IS A BRILLIANT IDEA! and I fully support it. Look, The Daily Mail have made clear that GPs are all greedy, over-paid, moronic parasites who prey on the NHS so I'd much rather take a back seat and leave it all to the "clever doctors" up at the hospital. Bring it on!!

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  • Just when you think it couldn't get any worse.....
    I cannot believe the stupidity of some of these ideas and how ill informed these people are. What is even more worrying is that politicians who run the country (ha ha) in both parties, don't have the intelligence or knowledge to see through these stupid comments and dismiss them out of hand. The mere fact that Labour are considering this fills me with despair. Things will clearly not get any better if this lot get in. I wish I was a doctor, so I could emmigrate to Oz, but as a humble practice manager, I am doomed. We're all doomed Mr Mannering.

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  • I AGREE THIS IS A BRILLIANT IDEA! I have a very long list of patients that I would recommend particularly to be included in a direct access list for hospital specialists. I can assure you that the hospital doctors will never want for work again and will happily go up to the hospital on a weekly basis to see various specialists. In fact I would recommend that they have yearly colonoscopies, endoscopies and a full body CT scans as no doubt their symptoms will require these investigations anyway so they may as well have them before they come in for their out-patients appointment......

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  • Yes - finally! (am sure I'm not alone in having given this view in one of the consultation documents). This IS a way forward - for some problems but not all. Agree 8.09. And GPs act as bottle necks - the frustration of being called back to talk about a problem repeatedly, appointment anguish etc and then a wait to see the consultant anyway. It is similar for those referring to the private sector isn't it: where I am based these patients simply turn up and ask for a private referral. The more switched on practices will fax one over if a note is left at reception. Saves heaps of time. We don't even get to see an X-ray (that doctors in other countries think is a joke). The pathway for some conditions at the moment involves patients turning up multiple times to practice nurse, GP, OOH and A+E each time using up valuable doctor, nurse and admin time and that's before they even make it to a physio or secondary care. They're simply 'shopping' - not their fault - they just want to be sorted. Has anyone ever costed such a patient journey? Agree 8.33 too.

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  • Part of me thinks this would actually be quite funny to watch.

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  • Quite the craziest idea I have encountered in a very long time. Fact is, many patients do not know which service they need and which , if any, is likely to benefit them., but their G.P. with few exceptions does. It would inevitably lead to needless referrals and waste of a great deal of resources. Fortunately even politicians are nor daft enough to ever give this idea backing.

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