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Analysis: Hunt’s plans to reform primary care take shape

As GP negotiators get ready for the upcoming contract face-off, Sofia Lind evaluates what Mr Hunt wants from GPs – and whether this can really be delivered

Jeremy Hunt was expected to bring calm to the NHS after the tumultuous events of Andrew Lansley’s tenure at Richmond House. The reality, however, has been very different.

After a series of set-piece speeches that offered only dark hints of what he had in store for GPs, he has finally put some meat on the bones of his plans for ‘profound reform’ of general practice in England.

The political message hammered home throughout a summer of sabre-rattling was clear: that the 2004 GP contract had been ‘disastrous’ for the NHS. But now he has begun to spell out the detail, outlining in a landmark speech at the King’s Fund last month a series of major contractual changes he wants to see in place by April.

These include GP’s new responsibility to be a ‘named clinician’ leading on 24/7 out-of-hospital care for elderly patients, a major reduction in ‘box-ticking’ targets and the creation of electronic care plans for vulnerable patients.

Mr Hunt has also made the case for a shift in funding towards GPs and has echoed the RCGP’s recent call for more GPs to be trained.

He has indicated that his ‘named GP’ plans for the elderly represent the first year of a four-year focus on improving the care of vulnerable older people, those with long-term conditions, mothers and young children, as well as preventive medicine.

Mr Hunt also claims to recognise that GPs ‘work hard and need time off’ –although the profession has every reason to be sceptical after the imposition of the onerous GP contract in England this year.

GPC negotiators say there is some ‘shared ground’ with Mr Hunt’s proposals, but stress that the current workload pressure on GPs must be eased if they are to adopt a wider remit.

With NHS England also conducting wide-ranging revisions of the QOF, the Carr-Hill formula and other practice funding streams – and even talk of a brand new GP contract in the offing – GPs are bracing themselves for an unprecedented shake-up of practice funding next April.

As ministers and GP negotiators gear up for what could prove to be a decisive round of contract negotiations, we look in detail at what Mr Hunt is asking for – and whether it can really be delivered.

Jeremy Hunt plans graphic - online

What do GP leaders think?

We believe that we have a lot of common ground in terms of aspirations for patient care, but ultimately what needs to be addressed are the obstacles that are preventing GPs and practices from developing and expanding their services. We are looking forward to direct dialogue with the Government to enable GPs and practices to deliver some of these common goals.

Dr Chaand Nagpaul, GPC chair

This is a real chance for a renaissance of general practice – for the service to focus on people rather than diseases, move away from the tick-box culture of the QOF and get back to our values and our professional roots.

Dr Michael Dixon, NHS Alliance chair

This will not end the crisis in general practice. We urgently need a clear commitment for sufficient funding to enable general practice to deliver more services for patients.

Professor Clare Gerada, RCGP chair

The named clinician is essentially what general practice should be all about, which is a sense of community and ensuring population health. But we have been encouraging a decluttering of primary care so that GPs can deliver this.

Dr Charles Alessi, NAPC chair

Read more: Analysis: How the Government’s blueprint for the scheme will work

Devolved nations go their own way

For the first time, the four UK nations will have separate contract talks this year, in a move that signals the end of the UK-wide GP contract from next April.

Following the breakdown of contract talks last year, the governments of the devolved nations have decided not to mandate NHS Employers to represent them in negotiations over the GP contract, although the Welsh Government has charged the body to negotiate its QOF terms only.

The move comes despite the GPC’s determination to maintain a collective approach to negotiations and will mean that the devolved nations will be free to offer radically different terms to negotiators, rather than merely adjusting a UK-wide deal as in previous years.

The Welsh Government is likely to want increased access and progress on phasing out the MPIG, while the Welsh GPC is likely to focus on GP retention and recruitment and blocking the introduction of NHS 111.

The Scottish Government is set on integrating health and social care and avoiding any increase in health spending. But the GPC will push for as little contract change as possible and for GPs to have a say in commissioning integrated health and social care.

The Northern Irish Executive is likely to want to push ahead with its ongoing Transforming Your Care programme, while the GPC will argue that the QOF should be cut back to free up funding to care for the frail elderly.

Readers' comments (12)

  • I am just waiting for them to impose OOH or overnight responsibility for the elderly.

    My resignation letter is already written. I am one of hundreds if not thousands whose line in the sand is drawn.

    Hunt may think he can control events but he may have a nasty shock just before the next general election.

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  • Hunt is an emotional dwarf. He will ruin General Practice sometime soon.

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  • Martin Kittel

    Of course GP surgeries can be opened 8 to 8, 7 days a week, but such proposals need major re-organisation of GP services and I fear these re-organisations would be at the expense of quality of care and patient satisfaction. Surveys all over the country have shown over and over again, that small local practices, in fact single handed GPs, where patients are known to their doctors, have the highest approval ratings. However, similar to out of hours services, GPs would have to work shift and rarely see and communicate with each other in order to provide the service requested. GPs would just not be able to see each other and talk about ever more complex patients in a multidisciplinary fashion and we would have to spread ourselves very thin to even achieve cover.

    Furthermore we would have to fuse into super-practices with 50000 patients and more to achieve working time directives, sick and holiday cover and the flexible working hours the increasing female workforce needs. Patients and doctors would be detached and patients would never see the same doctor. The current partnership model would seize to exist and Kaiser Permanente, Virgin and Assura Medical led super health centres will employ ever cheaper doctors sourced from far away, because the already unattractive career option of being a GP would become even more unattractive to home grown professionals. Quality of care issues, similar to hospitals and out of hours services, would become a real issue also in primary care in these TESCO style sickness supermarkets. These sickness supermarkets are achievable in bigger cities, but I would not know how to achieve this in thinly populated areas.

    In my practice we are trying to recruit only the highest quality doctors and the market, particularly in the South East, is very low in quality staff. It is getting harder and harder to recruit good doctors. Staff one can get often has childcare issues and often cannot or is not prepared to even work the current working hours (we are running a walk-in flu clinic on Saturdays and only partners are providing, our salaried doctors do not want to do this). And once the newest doctors come through, who have to re-pay £100,000 in student loans, nobody will want to be a GP. The last bit of compassion will leave the NHS and the elderly and vulnerable will be left to untrained HCAs and care staff.

    I am not sure where Jeremy Hunt will get all these new and extra doctors from. Morale in the current workforce is at an all time low. GPs are already working flat out in order to satisfy increasing demand and need from patients and government alike. Ever more complex patients, treatment pathways, care conferences, report writing, longer and longer list of chronic conditions and medications require expert knowledge, care and dedication. The government wants us to provide increasing amounts of care in the community. The current partnership model is excellent in order to deliver this, but the current access plan (8 to 8, 365) would destroy the current model forever. Once unpicked, it will never come back again. Our own and future generations, working so hard at the moment, will get older with very little compassionate or even technically adequate care.

    And who really wants all these extended opening hours? Not the elderly (they like to come in the morning during the week and see their grandchildren at the weekend). Not the disabled. Not the retired with chronic conditions and not the vulnerable. Much of the additional hours would be taken up by the never ending stream of self-limiting viral illness, cough, colds, runny noses, which really need better self care.

    I wonder which big healthcare providers Mr Hunt is talking to and who is lobbying the department of health to get their fingers into the primary care, which has been quite resilient to the American large corporate providers, so far. Once they are in, they will destroy the NHS primary care model, forever. Its not too late, yet, but it may be too late, soon

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  • We'll said Martin Kittel. GPs will become the new staff grade Drs. Like peripatetic teachers wandering from one short term job to another. General Practice is dying fast and politicians of all three parties have had a hand in its demise. The teachers are on strike today, supported by their union....anyone know what the BMA is doing?

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  • I was going to write something but Martin Kittel has said it all. It's a pity such intelligent views like this aren't being listened to more widely by our Government, and the people.

    I hope to see a lot more fight from our representative bodies over coming months, though I'm not holding my breath.

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  • Indeed. So what do we think WOULD work to improve the situation. What would we do with more money? How CAN we ensure that the skills are there?

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  • I agree 100% with you Martin Kittel . I'd also like to know how a 'named clinician system' ( which we already use in our practice for vulnerable patients) can possibly be implemented along side these extended hours proposals that are antithetical to continuity of care.....

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  • From a patient's viewpoint, it is timely appointments one seeks. Not waiting for a week for a GP. From a GP's viewpoint, we are working way beyond danger levels already. All the recent Inquiries and reports [ Francis. Keogh, Berwick] point to poor staff ratios, inadequate staffing leading to overwork, burn out , depression and of course, consequentially poor care.
    The real reason for very poor care is lack of funding and it is Mr. Hunt who is directly responsible for this, though he deflects attention by blaming doctors.
    The NHS staff, in both primary and secondary care, that I have known in almost 40 years, work themselves to the bone and way more than they should, only then to be criticized.
    We have to define safe working practices first and foremost, before everything to demonstrate clearly to the public, who have genuine reasons to complain, that the problem lies squarely with the Minister of Health.

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  • Vinci Ho

    About the lobbying , remember what David Cameron said that would be the next political scandal in 2010.
    One thing must be clear , we serve for our patients , hence people not a government .......

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  • Being a non GP but working alongside partners, salaried and foreign Doctors, I have to support them in their claims of "overworked, underpaid, and over ruled by state game players". However as an ECP I do feel that skills from highly experienced 'others' are being overlooked in this debate. The medical profession as a whole has historically been a closed shop, you need to open your doors and your minds to us poor minions, accept and embrace our skills and our wishes to help keep our patients safe. And realise that we could well be able to stop you all from burning out!

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