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At the heart of general practice since 1960

NPfIT is a threat to everyone not just practices with EMIS

With GPs opting out in large numbers, your views differ on who should control out-of-hours care

You have been writing about an apparent conflict between out-of-hours models of care. The National Association of GP Co-operatives strongly believes independent not-for-profit providers of out-of-hours primary care give the best value for money and provide excellent quality care for patients.

A GP-only model was seen not to be sustainable by many GP leaders. There are many successful examples of co-ops working with nurses. This model is more relevant given that nGMS is in place and significant numbers of GPs are opting out of working.

The future will therefore consist of more integrated services in which GPs must play a leading part. Co-ops, in whichever form they take, will be well placed to play a key role in providing out-of-hours care across the country. The managers, staff and GPs have a great deal of experience which will prove invaluable in this new world.

We have worked with the Department of Health, the GPC and others to consider future models of care. Independent not-for-profit providers, whatever they might be called and however constituted, are widely recognised to be the best way forward.

The existing co-op structure, doctor-owned and led, has much to recommend it. In many parts of the country other models of care might better fit local circumstance. For example, for now, in some areas the service might have to be delivered by a PCT 'in house' model. One other choice is the community benefit society. A number have already been set up with others in the pipeline.

The NAGPC council deliberately decided to assess the situation in September. The picture has become clearer with GPs, PCTs and providers having made their choices. It has always been obvious that these changes would affect the NAGPC. Now we know the situation, the NAGPC will be taking guidance from its members. We are actively looking at the needs of those running the services, from GPs to CEs, to work out how we can support and develop good-quality out-of-hours patient care under the new contract.

The way ahead is now clearer for the NAGPC and our members will be hearing from us shortly.

Dr Mark Reynolds

NAGPC Chair

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