Minister reveals plans to bring in 'daytime out of hours'

05 Nov 09

Speaking at the RCGP conference in Glasgow, Mike O’Brien said it may be possible for GPs to relinquish responsibility for daytime home visits for patients who chose to register at practices far away from their home.

Responsibility would fall on third party providers such as existing out-of-hours companies.

But the plans came under a barrage of criticism from GPs, who claimed the move is unworkable and will damage patient care.

Mr O’Brien was forced to defend plans to scrap boundaries, after GPs from the audience warned they risked jeopardizing the holistic nature of general practice.

The minister admitted details of how the plans will work in practice still needed much ironing out but attempted to reassure GPs by saying he did not expect many patients to move practices.

Mr O'Brien said: ‘The reason we’re doing this, is not because we believe large numbers of patients are going to start switching from one practice to another. I don’t think that’s likely to happen. Most people will stay with the GP they currently have.

‘But we do know that some people, particularly younger people, who are working in a big city, may want a GP in the centre of the city.

He added: ‘That will produce the issues of how you arrange visits. That will need to be worked through in detail as to how that will be delivered. It could be through a daytime out-of-hours service, there are a number of ways in which this could be delivered. The patients who make those decisions to move GPs will have to bear in mind who they want to visit them at home.

‘I know some people will be concerned, but patients want that element of choice.’

But GPs from the audience were left unimpressed with the claims. Dr Chris Walker, a GP in Wolverhampton, received a round of applause from delegates after expressing his concern at the plans.

Dr Walker said: ‘If we’re going to have a holistic view of patient care, with an emphasis on palliative care, and if we’re really keen on training GPs, part of that is going to be in the home. How will we be able to visit patients if they need, for example, palliative care, if they live 5-10 miles away?’

RCGP chair Professor Steve Field told Pulse that while he was open to discussing the abolition of practice boundaries, he was not in favour of a ‘daytime out-of-hours’ arrangement.

He said: ‘When I was in Australia, I saw GPs give up visits during the day. To me, this was not a good use of local health resources, and fractured the continuity of care that was needed.’