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GPC revises opposition to RCGP out-of-hours suggestion

The GPC has reversed its opposition to proposals by RCGP chair Professor Clare Gerada for GPs to work in federations to improve out-of-hours care for vulnerable patients after the college clarified its position.

GPC members expressed support for practices to work in federations or co-operatives and agreed that there is a need for patients to be supported out of hours.

Last week, Dr Laurence Buckman, chair of the GPC, responded to the college’s proposals by saying GPs do not want to take back personal responsibility for providing out-of-hours care, while offering care for some patients and not others was ‘discriminatory’.

However, the college has since clarified Prof Gerada’s comments. It said that while she saw GPs working in federations and with a range of other professionals as a way of improving out-of hours care for key groups of patients, she was not proposing GPs take back personal responsibility for patients out of hours.

Following the college’s clarification, Dr Richard Vautrey, GPC deputy chairman and RCGP council member, said practices working in federations to improve out-of-hours care was a viable option.

He said: ‘The RCGP made it clear that GPs wouldn’t be taking personal responsibility for round-the-clock care. There wouldn’t be support for changes in OOH arrangements making GPs responsible for patients.’

He added: ‘There is a need to ensure the patients are supported in and out of hours and that GPs ensure continuity of care. Federations and co-ops - they’re certainly options. GPs within CCGs might also want to wield their power to make out of hours into a more integrated and coordinated system. That can be done without contractual change.’

GPC negotiator Dr Peter Holden said he had worked up a document on out of hours to be debated at the next GPC meeting on 20th June, which would address the RCGP’s proposals.

He said he could not pre-empt the outcome of the GPC debate, and was adamant GPs should not take back personal responsibility for out-of-hours care: ‘The college needs to understand that they need to tread carefully with this. There is no way we are ever going, individually or as practices, back to before the 2004 contract. We cannot provide the service the public desire, we can provide the service they need.’

However, he did not dismiss the idea of practices working in federations to provide out-of-hours care.

He said: ‘Federations and co-ops are a different kettle of fish. Federations can be an enormous operation. It has to be so high up the food chain that there is no pressure on individual practices.’

The college said it would be detailing its position in its document “The 2022 GP - A Vision for General Practice in the future NHS”, which it says will be launched ‘shortly’.

The college added: [The 2022 GP document] suggests ways of improving out-of-hours care by reshaping services to deliver better care and better co-ordination of care for patients. One of the ways of achieving this is by involving a range of professions - medical, nursing, pharmacy and social care.’

‘Working together across federations of practices would also lead to better out-of-hours responsiveness and allow us to develop different models that are able to address the needs of different populations of patients, such as the frail elderly.’

A statement from the college added that this would not be achievable without major investment and support for general practice.

However, two RCGP council members told Pulse they remained opposed to the RCGP’s stance, and said they would vote against the proposal if it was put before the college council.

Dr Una Coales, who will officially return to the RCGP Council in November, said she will not support the proposals.

She said: ‘Even if it’s the 5%- the elderly population is in millions.’

‘If you look at the American model and other countries’ model out of hours there is always a geriatrician to be in charge of care. GPs can’t be two roles- we can’t be a patient’s GP and a geriatrician out of hours.’

She said being selective about which patients receive out-of-hours care is morally wrong: ‘It’s also not fair with regard to equity. Morally it’s not right to preselect who should have care out of hours and who shouldn’t. Everybody in the NHS should be treated the same.’

RCGP council member Dr Bob Mortimer also said he rejected the proposals as they were based on the assumption that out-of-hours services are failing and in particular failing for patients with complex needs.

He said that in his area there is already a highly effective GP out-of-hours service which is regularly used for patients with complex health needs and already works closely with the emergency department and other health professionals.

Dr Mortimer said: ‘I don’t perceive that an additional service provided by doctors working in federations would provide any added value.’

He added that reintroducing out-of-hours work would cause problems attracting GPs: ‘There are clearly also implications for recruitment – GP morale and recruitment problems were the main reasons for the change in the out-of-hours contract. Reintroducing compulsory out-of-hours work and increasing the workforce by an additional 10,000 GPs are in my view mutually incompatible.’