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At the heart of general practice since 1960

Taking back out-of-hours care is not an idea the profession should dismiss

Birmingham LMC executive secretary Dr Bob Morley urges GPs to stop and consider, for a moment, whether taking back out-of-hours provision would be such a bad thing

There is a lot of confusion over the matter of GP responsibility for out-of-hours.

The fact is that, through their membership of CCGs, all practices have been responsible for commissioning out-of-hours since April. For commissioning read accountability and therefore blame, but, of course, no actual real power or control.

CCGs have been set up to be the ‘fall guys’, and have been given an impossible job even more so than any predecessor commissioning organisations. Remember the nonsense of PCTs having ‘doctors and nurses in the driving seat’? Any real power CCGs think they have is even more illusory; they will have to do what their NHS England masters tell them at a time when the NHS is being crushed between the rock of unprecedented increase in demand and the hard place of an unprecedented funding squeeze.

Out-of-hours provision across the country is therefore a complete dog’s breakfast, giving GPs the worst of all worlds at present. It is a public relations disaster for us, inevitably being fuelled by a political and media campaign of vilification against us.

Best-case scenario

If GP practices were to be handed back responsibility for out-of-hours provision as well as commissioning, that would not mean they would have to personally provide it and it is not something the profession should dismiss out of hand.

It is ironic that we constantly bemoan the fragmentation and privatisation of general practice yet are happy to wash our hands of the GP care of our registered patients for two thirds of the week, thereby having ourselves contributed to its fragmentation and privatisation. Quite simply we need to get rid of the mindset of out-of-hours responsibility meaning personal delivery: it doesn’t and it won’t. But no-one would be able to run GP co-ops of sufficient size and capacity as well as we could to make sure the job is done as well as possible within the resources available.

Many GPs have in fact remained opted in to out of hours responsibility, subcontracted to excellent GP co-ops. Extending this model needs to be explored.

The situation we have arrived at is unsustainable but was entirely predictable in 2004. The 111 fiasco has of course worsened it but is not the only reason. We shouldn’t be afraid to look at radical options that at least offer the possibility of doing something better. How about forming a nationwide GP co-op with the resources and capacity both to improve out-of-hours and unscheduled care and to make all our working lives better?

Clearly it would be contingent on appropriate funding and safeguards, but I would back us to deliver both a better service and better working lives.

Dr Bob Morley is executive secretary of Birmingham LMC and a GP in Birmingham

Readers' comments (11)

  • Well said Bob
    as you point out , GP's have already taken back reponsibility , so why is J.H still moaning.
    what i think he means is finacial responsibility , back to the old days where GP partners were paying approx 1000 pounds a month for OOH delivery and havinig an on call system in case the OOH doctor did not turn up.
    As the number of GP partners drops ( retirement , resignation , moving abroad etc ) , the cost to provide this will be punitive; i estimate it to be much more than 1000 pounds/ month , this added to already to punitive repayments on surgery loans to pay off those who are leaving , and the little impetus by junior GP to take on dept ( i dont blame them , i would do the same, it is just what i notice ) , my concern is that GP surgery will be colapsing under the weight and there are signs of this already happening in NEE ..

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  • If individual GPs or practices were forced to take over responsibility for OOHs - presumably at the additional income of £6000 per partner: pity those practices with vacancies! - what would s75 competition regulations (and requirements to tender contracts) say if OOH contracts were awarded to a GP co-op *without* being put out to tender? and would there be any competition law implications if all the practices in the locality contracted with the same GP co-op?
    Just asking...

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  • Counting down the days to voluntary early retirement. Woodwork tools oiled and sharpened and waiting!!

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  • What does JH mean exactly when he says "GPs should take back responsibility for OOH provision" ?
    What does he actually propose GPs should do ? I would be quite interested to see the "details" !!

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  • What is the difference between the current system and that which is being described here? I think what the government mean by giving OOH back to GPs is giving back responsibility for delivery, because they have been proved to be incompetent at doing it via the NHS111 fiasco.

    Patients want to see their doctor OOH, and if it is not their doctor they don't care if the doctor works as part of a co-op or private OOH provider or whatever.

    Be careful what you wish for, Isay...

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  • I am not having Jeremy Hunt doing a handless PR on me thanks

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  • At last - some moderate thinking. Well done. Now we can have a sensible debate about how we go forward. Personally I wonder if the choice and competition legacy is the main cause for this.

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  • No Gp should take the OOH responsibility All governments want the service to be provided on the cheap. They would never reimburse the true or market price . All they want is to shift the blame on Gps.it will be returning to the old days of slavery.I was the Gp who first wrote in 1987 in GP magazine that no Doctor should entertain the idea of 24 hours commitment.It it took almost 226 years before Gps were relived of this very punitive and mad contarct

    Dr F.M.Hirji
    Grovehill Medical center
    Hemel hempstead HP2 6AD

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  • Interesting point Dr Hirji. The profession agreed that £6,000 was the true market price when they opted out. So what is/what was the true market price? Want to pay back some cash?

    You are bleating for bleating's sake. Bob Morely has a serious point, so pay attention.

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  • Mike Ogilvie

    Bob Morley is talking common sense.
    I have seen evidence and believe that GPs are capable of thinking laterally to find a solution better than is being proposed.
    You must not make the mistake of always thinking you have to merely take responsibility to repeat the existing model.
    I remember well when two GP clients In Doncaster Andrew Marshall and Paul Wilson took the lead to help form Danum Doctors , a cooperative of local doctors.
    What they did differently was to set up the service in the old Ambulance Station across from the hospital, and then they then set about the difficult task of educating the local patient community to understand that out of hours was not just a convenient extension of the doctors surgery service, and trained them to come in to the out of hours centre, and not to expect visits to their houses unless they were very ill or terminally ill, the argument being that if it was an emergency the patient should be going to A&E. This way the service was able to deliver dramatic cost savings to the traditional model .
    I believe a motivated group of GPs will be able to deliver a better solution than what is currently being provided.

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