This site is intended for health professionals only


Labour policy review group to consider radical plan to ditch GPs’ gatekeeper role



Exclusive GPs could have their ‘gatekeeper’ role removed and see patients given direct access to specialists, under radical plans being considered by the health and care policy commission set up by the Labour party.

The plans – submitted by trade union representatives to the Labour policy committee – would mean a ‘multidisciplinary team’ would take charge of an individual patient’s care, with the GP’s role scaled back.

In an exclusive interview with Pulse at the Labour Party conference in Brighton, Rachael Maskell, head of health at Unite, said the change was needed to move patients through pathways ‘much faster’ and ensure they get the services they need.

But the GPC warned that removing the responsibility for GPs to be patients’ advocate would ‘undermine general practice’ and ‘bankrupt the NHS’.

The plans come after Labour leader Ed Miliband promised to ‘save the NHS yet again’ if the party is elected as the next Government in 2015 and shadow health secretary Andy Burnham said that if Labour won the election, one of its first acts would be to repeal the coalition Government’s NHS reforms.

Ms Maskell is a member of the health and care policy commission, which is charged with setting the overall direction of health policy for the Labour party.

She told Pulse that Unite had submitted ideas to the commission looking at how ‘GPs can be GPs again’ and how Labour could empower the profession to do what it does best.

She said: ‘We are looking at access and think it is wrong that GPs are the gateways to the whole service. Because different specialisms are the expertise for that particular area of specialism. We don’t see why GPs always have to be the gatekeeper.’

She added: ‘[The policy] is looking other people in the [health] system and the possibility of getting direct access. At the moment, they have to pass an extra block in the system by seeing the GP which doesn’t free them up, it just clogs them up. It is very much about moving people through the pathways much faster and getting the services they need, from the practitioners they need… GPs being part of this multidisciplinary team but not the lead, necessarily. Because I think that is a model of the past.’

Ms Maskell said that the union wanted to restore the ‘clinical significance’ of GPs, but warned it could not guarantee any additional funding would be provided.

She said: ‘We are not talking about money going to GP in the future; it is talking about money going to the right place in the service. So as I said, GPs shouldn’t be the gatekeeper to the service, so it is not about money going direct to GPs. It is going into the service in the appropriate space.’

‘We have to be real, GPs aren’t the cheapest part of the service so there are other practitioners who are highly skilled, highly trained and advanced in their clinical skills, diagnostic skills, treatment skills and prescribing skills – and therefore we have other parts of the service which can actually lead those services and take them forward. It shouldn’t be a GP-led service.’

The ideas have been submitted by Unite to Labour’s health and care policy commission and will be reviewed ‘along with all other submissions as part of a democratic process’, said Ms Maskell.

But GPC deputy chair Dr Richard Vautrey said the union’s ideas would be completely unworkable and would cost more in the long run.

He said: ‘This would bankrupt the NHS and completely undermine general practice in the process. It is time politicians woke up to the massive benefit general practice and GPs as specialist generalists provide – it is the reason the NHS remains sustainable.’

A Labour party spokesperson said: ‘Labour’s policy review on integrated health and social care is looking at breaking the silo-mentality and moving away from a strictly medical model of commissioning.’

Asked to clarify whether that meant the party backed the Unite proposals, the spokesperson added: ‘It’s tough. It’s not being looked at in those terms, but the integrated care review will change that outlook – just in a much more fundamental way.’