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GP responsibility for out-of-hours care to be reviewed as Hunt attacks ‘inaccessible’ primary care



A major NHS review will consider the possibility of GPs taking back out-of-hours care, as the health secretary reiterated that ‘inaccessible primary care’ was to blame for the rising pressure on A&E departments.

The Department of Health said that it had asked NHS England to review out-of-hours care, and refused to rule out whether this would include considering whether GPs should take back responsibilty for out-of-hours care.

In a speech trailed in the Telegraph today Jeremy Hunt will say that the DH is trying to ‘address the systems failures’ that followed the decision to remove GPs’ responsibility for out-of-hours care in the contract negotiations in 2004.

Mr Hunt will use the speech to expand on his comments last week in Parliament saying the 2004 GP contract was ‘disastrous’ for the NHS and blaming GPs for high attendance at A&E departments.

NHS England’s medical director Sir Bruce Keogh is currently reviewing emergency and urgent care and has previously confirmed that GP working hours will form part of that review.

Mr Hunt will today say: ‘When I have been visiting A&Es in recent weeks, hard-working staff talk about the same issues: lack of beds to admit people, poor out-of-hours GP services, inaccessible primary care and a lack of coordination across the health system.

‘The decline in out-of-hours care follows the last government’s disastrous changes to the GP contract… We must address these system failures, and I am determined we will.’

Following Mr Hunt’s comments, a DH spokesperson refused to rule out the Keogh review concluding GPs should take back out-of-hours care, as suggested in media reports, saying it was currently only ‘speculation’

‘It is far too early for us to get into the details of what the proposals may or may not be for change ,’ she said.

The GPC wrote to Jeremy Hunt last week demanding an urgent meeting to discuss the comments he made in the House of Commons. However GPC chair Dr Laurence Buckman confirmed this morning that Mr Hunt has neither agreed to meet, nor even acknowledged the GPC concerns.

Dr Chaand Nagpaul, also a GPC negotiator, said: ‘Clearly we feel his comments are inexplicable and Jeremy Hunt needs to reconsider his position, which is an insult to the profession. It does not reflect the effort and hard work of GPs and throws allegations about GPs performance which are not substantiated.

‘I think that it was completely inappropriate and erroneous to bring up the contract in this way for political reasons alone. The contract has no part to play with regards to the issues he is describing. In fact the contract has resulted in a reduction in resources to general practice over the last three years.

‘The GP contract from 2004 is remarkably flexible and fit for purpose for the future. The issue that has created problems is how the Government has made use of the contract in a punitive way. In recent years the contract has been used to add workload without adding resources which is the opposite to what was intended when we first negotiated this contract, and a contract which this year has not been part of a two-way dialogue.’

Meanwhile Dr Peter Swinyard, chair of the Family Doctors Association has asked civil servants at the Department of Health to convey to Mr Hunt how ‘demoralising’ his comments are.

This speech follows comments by junior health minister Dr Dan Poulter on BBC Radio Four’s Today programme yesterday, which sparked GP outrage on Twitter. Dr Poulter said that ‘there is no GP out of hours’ and said people turn up at A&E at times when they don’t have access to their GP.

Dr Poulter said: ‘If you look at the data, the particular period when there is a spike in activity in A&E tends to be over the bank holiday weekends, over the Christmas weekend, over New Year and over Easter weekend in particular. Over those weekends, going back to the point I made earlier, there is of course [that] GP surgeries are not open. There isn’t the community-based care that there used to be, thanks to the previous Government scrapping the GP out-of-hours system and that has put a lot of pressure on the system.

‘It means that we are in a much more difficult place to deal with and actually better help people who could be better looked after at home in their community, and indeed divert less serious cases, for example someone with a sore throat, who would normally turn up to their GP, they are now sort of being forced to turn up at A&E because they haven’t got a GP to see out of hours.

‘That is a very real problem in the system and something that we, through the review that Sir Bruce Keogh is leading […] he is leading a review for how we can improve the NHS under this Government and move to a more 24/7 system.’

Dr Poulter’s comments immediately saw a Twitter backlash from GPs, with Dr Joanne Bailey, GPC member and a GP in London, tweeting: ‘Inaccurate damaging statements by MP Dan Poulter about GP outofhours on @BBCr4today went unchallenged! #NHS111 to blame for recent fiascos.’

Dr David Wrigley, a GP in Lancashire who is also on the GPC, tweeted: ‘Twaddle from Dr Dan Poulter MP on #radio4today about GPs not working out of hours. We staff every OOH shift! Why not invest in more staff?’