This site is intended for health professionals only

At the heart of general practice since 1960

pulse june2020 80x101px
Read the latest issue online

The waiting game

RCGP sparks row over GP out-of-hours care for complex patients

The RCGP has called for practices to ensure better 24/7 care for a small number of elderly patients and those with complex health needs, sparking a row with the GPC who called the proposals ‘discriminatory’.

The RCGP called for practices to work in federations and with other professionals such as nurses and social workers in order to improve out-of-hours care.

It follows health secretary Jeremy Hunt’s call for GPs to take back responsibility for out-of-hours care, a call that was rejected by the LMCs Conference last month.

The college told Pulse that their document The 2022 GP - A Vision for General Practice in the future NHS - to be published soon - will suggest different models of improving out-of-hours care.

These would include ‘reshaping services to deliver better care and better co-ordination of care for patients’.

In an interview with the Guardian published today, RCGP chair Professor Clare Gerada said one solution was for GPs to take back out-of-hours responsibility for key groups of vulnerable patients, such as the elderly, patients with complex medical problems and those needing palliative care or with mental health problems.

She told the newspaper that as this involves only small number of patients - 5% of all patients across the UK - it would not signal a move to before the 2004 contract, when GPs were frequently on-call at night or over the weekend.

Federations of 10 to 15 practices could come together to provide this care, and other professionals could also provide out-of-hours care, reducing the frequency of evening weekend work for GPs, she said.

She clarified this move would only be possible if 10,000 more GPs - the equivalent of one per practice - were trained.

In a statement sent to Pulse, a spokesperson for the RCGP said their upcoming report would suggest a range of ways of improving out of hours care.

They said: ‘Our document The 2022 GP - A Vision for General Practice in the future NHS, which will be launched shortly, suggests ways of improving out of hours care by reshaping services to deliver better care and better co-ordination of care for patients.’

‘One of the ways of achieving this is by involving a range of professions - medical, nursing, pharmacy and social care. Working together across federations of practices would also lead to better out of hours responsiveness and allow us to develop different models that are able to address the needs of different populations of patients, such as the frail elderly.’

They added that major investment in primary care is needed, and that going back to before 2004 when GPs were working unsustainably long hours is ‘not an option’.

But the move was not welcomed by the GPC. GPC chair Dr Laurence Buckman said GPs do not want to take back personal responsibility for providing out-of-hours care and offering care for some patients and not others was ‘discriminatory’.

He said: ‘GPs don’t want to do that. It’s quite clear. To take it back for some and not others is unfair and discriminatory. How would you decide who gets care and who doesn’t? How would you justify this to someone who’s just missed the 5% test?

‘The conference of LMCs was quite clear that GPs do not want to take back personal responsibility for out-of-hours. That doesn’t mean we don’t want to organise it, and there may be GPs using power through CCGs who want to see better care through commissioning.

‘But I’d defy you to find many GPs who look at Professor Gerada’s proposals with enthusiasm. I’d be interested to see how many RCGP Council members back her on this.’

A DH spokesperson confirmed that health secretary Jeremy Hunt met with Professor Gerada on the 16 May to discuss out-of-hours care, but the RCGP denied they had met with the health secretary to discuss GPs taking back responsibility for providing round-the clock care.

Readers' comments (23)

  • Vinci Ho

    Editor , can you identify who is the DH spokesperson and quote exactly what he or she said?

    Unsuitable or offensive? Report this comment

  • Last week Jeremy Hunt made it clear that he did not want GP's working nights and weekends again, one of the few things that he has said that make sense.

    Quite why Dr Gerada wishes to argue against that point baffles me. This will be seized upon by those who do wish to see us knocking on doors at all hours. 5% would inevitably become 10%, 10% become 20%........... I am surprised that she cannot see that.

    D Gerada is elsewhere quoted as saying GP's are demoralised, we are more so now having been shot in the arse by one of our own.

    Thanks Dr G.

    Unsuitable or offensive? Report this comment

  • This comment has been moderated.

  • I am very disappointed with RCGP chairs - Prof Field, and now Prof Gerada. As soon as they are off the hot chair, they seem to want to work with the government.

    Perhaps Prof Gerada would like to be personally responsible for elderly population (>75s projected to be 22 millions in 2020, according to national office of statistics). So that's just like being oncall......... in 2003 then.

    Unsuitable or offensive? Report this comment

  • This comment has been moderated.

  • This is typical of the undermining, undemocratic action of the College over many years. If they had stuck to their brief fewer GPs would be retiring in droves or leaving for abroad.

    Unsuitable or offensive? Report this comment

  • Clare has a heart of gold.She means well.But she is not a military tactician.

    Unsuitable or offensive? Report this comment

  • This comment has been moderated.

  • Do I smell cottage hospitals coming back?

    Unsuitable or offensive? Report this comment

  • Hazel Drury

    One GP per practice you say? Hmmmm let's see.. ah yes, just me again then :-(

    Unsuitable or offensive? Report this comment

  • Does anyone else feel that the disruption to the life part of the work/life balance is almost as bad being on call for the 5-10% of the practice population most likely to need time-consuming interventions as being on call for 100%?
    When on call, you can't plan anything, can't be sure that you will not be so fatigued the following day that it will be possible to function let alone plan anything for self or family the following evening - and in my experience, knowing you might be phoned doesn't conduce to good quality sleep.
    What is the RCGP thinking of?

    Unsuitable or offensive? Report this comment

  • I totally agree with Mary Hawking. Being on call at all, even for 5% patients, would be completely unacceptable - we are already doing more than our fair share during our 12 hour days.
    Out of hours may be a mess, but the government seems hell bent on wrecking the core hours too (which cover the vast majority of consultations, including serious life threatening conditions).
    I will most definitely resign my partnership if out-of -hours is enforced.

    Unsuitable or offensive? Report this comment

  • I am truly shocked by the professional naivety of our RCGP Chair. To qualify her comments with a medium term unachievable recruitment aspiration does not mitigate the stress and destruction to the profession that this proposal would bring. Colleagues are at breaking point. Expecting a demanding subset of the population to have unfettered access to their exhausted GPs will just trigger a complete recruitment and retention melt down and put anyone off GP as a career for good.

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say