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GPs couldn't really be forced to take back out-of-hours responsibility... could they?

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Four weeks ago, Pulse first reported that Jeremy Hunt had decided GPs were to blame for the current intense pressure on A&E, after a series of remarks he made in an otherwise uneventful health questions in the House of Commons. 

At the time, the Department of Health was furious with our story, angrily insisting that Mr Hunt was not in fact blaming GPs, merely criticising the 2004 GP contract negotiated under a Labour government (though quite how Mr Hunt’s attack on ‘poor primary care provision’ was not an attack on GPs themselves was never quite clarified). 

Four weeks on, with the story very much front and centre of the national media agenda, no one would dispute that it is principally GPs who are getting it in the neck for the problems in A&E, and that GP out-of-hours services are coming in for a pasting.  

A clamour of criticism has risen to a crescendo this week with back-to-back Daily Mail front pages attacking out-of-hours care, fresh headlines this morning off the back of a College of Emergency Medicine report into A&E pressures and national newspaper columnists getting the bit between their teeth. (The Telegraph’s unfavourable comparison of GPs to vetsyesterday may generate the most outrage in practices, but it is the piece in today’s Times, headlined ‘GPs must work harder - it’s an emergency’ and written by the well-placed Alice Thomson, which is probably the more ominous.) 

What is all this building up to? Well, Mr Hunt has been very careful to commit to nothing explict, but the signs all seem to point in the same direction. Later this month NHS England medical director Sir Bruce Keogh will present a wide-ranging report on the future of urgent and emergency care, which will specifically consider the possibility of GPs taking back responsibility for out-of-hours care.

The recommendations of that report, it’s important to stress, are by no means a foregone conclusion. In my interview with him at Pulse Live, NHS England chair Professor Malcolm Grant played down the prospect of GPs taking back out-of-hours care. Nor do NHS England’s planned changes to the GP contract which we reveal today necessarily seem to align with the idea.

GPs, too, might have a little something to say about it. As Copperfield made very clear yesterday, there is probably no single action the Government could take which would more radicalise weary grassroots GPs than forcing them to take back out-of-hours. Older GPs still remember the bad old days - whole weekends on call, wives and husbands on phone-answering duty, peering at house numbers at 3am in the morning. Pensions didn’t do it, and the NHS reforms didn’t either, but force GPs to work the night shift again and you suspect many really would vote with their feet.

And yet… Mr Hunt has shown little sign to date of being overly concerned about his popularity among GPs. There are massive questions over how returning out-of-hours care to the profession could possibly work in practice - would it mean a return to co-ops? - but in the broader scheme of things, the practicalities are almost beside the point.

With the support of the national media and a general public already anxious over out-of-hours care thanks to the 111 debacle, unpicking the 2004 contract is an idea which seems to have the wind behind it.

Whether it would really solve the A&E crisis is open to debate; whether GPs have the capacity to absorb more work or the willingness to return to 24/7 responsibility is extremely doubtful. But unlike his predecessor, Mr Hunt is an extremely sharp political operator. And right now it’s looking like smart politics. 

Readers' comments (16)

  • I presume there are no comments on this article because everyone knows the answer to the question and it isn't No.

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  • Vinci Ho

    We need to be careful when we debate this subject . There is a difference between taking back out of hour responsibility and the actual GP surgery opening 24/7 . While the former could be just a straight return to dates before 2004 , the latter is mission impossible in current situation .
    But my beacon of conspiracy theory is flashing on 24/7 opening . Agent Hunt is using his wicked spin through the media to guide this through.

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  • I am old enough to remember a senior politicians speech to LMC conference, to the best of my memory at the time of discussion of the possible implementation of "the NEW GP Contract with Opt out"

    "in reality there are no circumstances in which we would return the Out of hours commitment to General Practice; it would be a damning inditement of comprehensive failure of the NHS reforms"

    They got one long term prognosis right then.

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  • If GP recruitment and retention were not an issue this might even be a possibility. HoweverI imagine it would be the tipping point for many a near to retirement GP. (those of course with the better pension) I feel I’ve been kicked enough when down, fix the out of hours, I’m deskilled, unmotivated and looking for a good reason to go, Go on Hunt, make my day!

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  • It isn't about treating threadworms at 3am surely it's about looking after patients with chronic or terminal illnesses over the weekend. At least restarting Saturday morning surgeries would be a step in the right direction.
    I am an older retired GP and I don't think of them as the bad old days!

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  • I voted against the 2004 contract because I could see the ever increasing work load of the QOF and GPs working like Hamsters going ever faster. The day time works has intensified beyond description. The quid pro quo at the time was the loss of the ooh responsibility. The old days weren't all bad but to pile ooh on GPs with the present day time work load and no doubt a derisory pay increase in compensation would be beyond the professions ability to swallow. I am thankfully in a position to retire immediately I feel very sorry for may younger colleagues.

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  • I seem to remember that the 2004 contract was introduced in part to prevent an impending collapse of GP recruitment . Many potential applicants were deterred by threat of trailing around the countryside/ tenement blocks on their own at night .. unsafe and unworkable . Look at history to foresee the future and think very carefully .

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  • How would you find the time to spend the extra money, anyway?

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  • Dr Challacombe, that's very easy to say as a retired GP who probably has little idea what is happening on the ground now

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  • Cobblers

    This has the potential to destroy GP as it currently stands. Mr Hunt (have I got that right?) understands this and would presumably will be aware of the danger of collapse of Primary Care and then the NHS. It would appear to be his agenda. I don't think the journos are as yet aware. Be careful what you wish for Mr Hunt.

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