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Gerada warning over ‘hospital closures’ claims

The head of the RCGP has warned that rhetoric urging the closure of NHS hospitals is ‘unhelpful' and damaging to attempts by GP commissioners to integrate care.

Speaking to Pulse, Dr Clare Gerada, RCGP chair and a GP in Kennington, said comments made by Lord Crisp, the former NHS chief executive, that the NHS is ‘inefficient' and staff need to work harder and hospitals should be closed to be sustainable, would pitch hospitals against GPs.

Dr Gerada said the NHS needed to focus instead on the ‘real issue' of removing the ‘perverse incentives' that see hospitals paid depending on through-put at the same time as GPs are incentivised to reduce hospital activity.

She said that the health service should focus on designing services around ‘patients not buildings' and invest in GPs to lead ‘integrated multi-disciplinary teams' to help integrate primary and secondary care. She said the NHS needed to boost the number of GPs, and the time GPs get spend with patients, in order to improve health service outcomes.

Dr Gerada said:‘This rhetoric about needing to close hospitals is unhelpful. We get too focused on buildings rather than patients – services should be designed around patients.'

‘Lord Crisp has been saying we have had too many beds for a while. I'm not a health economist – they will be able to look at the whole picture - but as a GP I know we need hospital beds and I know that in some of the hospitals I work with there are less beds available than when I started practising.'

‘I worry about pitching hospital services against community services at a time that we need to be working together. The issue that should be being tackled is the perverse incentives that exist for GPs and hospitals at the moment. Hospitals and foundation trusts are incentivised for increasing their activity, while GPs are incentivised to reduce hospital activity. Incentives need to be put in place that encourage us to work together to care for geographical populations.'

In an interview with The Telegraph, Lord Crisp said the ‘inefficient' NHS hospital structure ‘isn't being used to its full capacity'. He also said that several tasks carried out by consultants could be done instead by nurses.

Lord Crisp told the newspaper: ‘What we've got at the moment is an inefficient infrastructure that isn't being used to its full capacity.'

‘You've got beds closed and people not working to their full capacity because there are too many sites. In some ways we provide too many very highly trained people who then have to work below their capacity.'

Responding to Lord Crisp's comments, NHS Confederation deputy chief executive David Stout said:‘NHS leaders will have to make some tough decisions if the health service is to live within its means. This is a pressing issue and one that we must tackle now so that patients can continue to have access to the high quality care they expect.'

‘Now is not the time for inertia. But it is essential any decisions on changes to local services are based on evidence and have the support of clinical staff and local politicians.'