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
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