Exclusive Many of NHS England’s proposals for the future shape of urgent care are ‘not deliverable’ and lack detail, says GPC chair Dr Laurence Buckman in a robust response to plans that included GPs providing 24/7 ‘decision support’ for their patients.
Dr Buckman, giving the first indication of GPC’s response to the proposals published by Sir Bruce Keogh this week, railed against the suggestion that GPs should be available to provide ‘decision support’ out-of-hours and said many of the proposals in the report would only be deliverable by reinstating funding to GP cooperatives.
He said there was ‘very little’ he would disagree with the analysis in the report that the problems in emergency care were multifactorial, but said that the proposals – such as seven-day same-day access to a primary care team integrated with the practice – were completely unrealistic.
The report – published by NHS England this week – begins a consultation on a list of possible options to solve the crisis in the urgent care system.
Many of the proposals related to greater access to GPs out-of-hours – but not necessarily the patient’s practice – with more out-of-hours telephone consultations and giving GPs same-day access to specialist opinions.
But the most controversial proposal was for practices to provide 24/7 ‘decision support’. Dr Buckman said: ‘I can’t see how that is deliverable. I think the idea of having a doctor on the front line or very near it, in any kind of urgent care situation, is essential.
‘I think if it is a primary care thing then it should be a primary care physician and I think there are people who will do that, for money. For a suitable payment they’ll do it.’
He added that providing same-day access to a GP was something that should only be available for urgent and emergency care. He said: ‘If what they mean is on a Sunday, then I am sorry, you can’t deliver that kind of service unless for urgent and emergency matters. But I am not providing a routine service for things that are not so important.
‘I think the GP co-ops would have been admirably suited to the task if they hadn’t been defunded to pay for 111. That was what we said all along, that GP out-of-hours service provide, largely, a very good level of service, and if you take their money away they won’t be able to provide a good service and that is what’s happened.’
But Dr Buckman also said the analysis of the problems in the report was fair. He added: ‘There is very little in the Keogh report we would disagree with. I would share his analysis. Sometimes language is a bit loose, where I would say “Well where’s your evidence for that”, but even then I still agree with it.
‘His conclusions are: it’s confusing, there are too many entry points, a lot of money has been wasted, a lot of things have been set up that do nothing for patients, and he is right. All of that is right.
‘The level of out-of-hours service is variable, we know that, and that is because different out-of-hours providers provide different things and that is partly because different PCTs have funded different levels of service.’
The leader of the biggest LMC in the country, Dr Michelle Drage, chief executive of Londonwide LMCs, said she ‘would take issue’ with the BMA for welcoming the report, hinting at a possible row down the line between grassroots GPs and the trade union.
She said: ‘If you actually invest properly in in-hours GP services and support practices in taking on more doctors, more practice nurses and have a decent support service around them in the form of an extended primary care team, then you don’t need to go through these reviews and consultations which are a huge expense just to process to invent something that we know we could do if the service was properly run.
‘I find it highly unlikely that NHS England’s proposals will be welcomed by general practices, although I know that the chair of the BMA has welcomed the review and I would take issue with him for doing that because I think that yet again it leaves general practice out on a limb.’