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Independents' Day

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)

  • Good night ......
    Strange day
    Strange time
    Lets not divide
    All best

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  • We did meet on 16th May
    Odd meeting
    Certainly not friendly 'private meeting" .....and certainly not friendly. Was more about telling me that i was out of order for disagreeing with him.......!

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  • Dr Gerada has been doing a sterling job defending GPs but this suggestion is silly. 5% of the most needy patients would generate a great deal of work and we would become 24 hour community house officers

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  • "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%? "
    But this will be the 5% that generates 80% of the work!

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  • Spot on P G Paige.This illustrates that the proposal has not been thought through.Not something one would expect from someone in such a position of authority and influence.

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  • Why not start adopt a granny scheme.Bring her into your own home and look after her 24/7 365

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  • If I threw out my old lawn mower I could get at least two old people in my garage for the night. But I like my old lawn mower.

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  • Should we not be concentrating on providing better care in hours so that out-of hours was limited to genuine emergencies as it was when I started over 20 years ago? I do not mind being on for my palliative patients as that does seem to come infrequently and for short periods only. To be permanently on-call for those on my mental health register would lead to my own breakdown and subsequent lack of mental health provision.

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  • My senior partner still gives out her own phone number to terminally ill patient and adv them to call her (or NHS11 if it's switched off). I applaud her commitment but that's not a norm - majority of us don't wish to be contactable 24/7, unlike her my kids are very young and I cannot drop everything on a phone call.

    Patient demand is not going to go down, unless there is a significant break up of NHS (which I think the government is aiming for). So Trying to manage their demand is futile and not something that can be done in a matter of few months anyway.

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  • First has gone my BMA membership ... next will be my RCGP membership...

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