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RCGP sparks row over GP out-of-hours care for complex patients

The RCGP has called for practices to ensure better 24/7 care for a small number of elderly patients and those with complex health needs, sparking a row with the GPC who called the proposals ‘discriminatory’.

The RCGP called for practices to work in federations and with other professionals such as nurses and social workers in order to improve out-of-hours care.

It follows health secretary Jeremy Hunt’s call for GPs to take back responsibility for out-of-hours care, a call that was rejected by the LMCs Conference last month.

The college told Pulse that their document The 2022 GP - A Vision for General Practice in the future NHS - to be published soon - will suggest different models of improving out-of-hours care.

These would include ‘reshaping services to deliver better care and better co-ordination of care for patients’.

In an interview with the Guardian published today, RCGP chair Professor Clare Gerada said one solution was for GPs to take back out-of-hours responsibility for key groups of vulnerable patients, such as the elderly, patients with complex medical problems and those needing palliative care or with mental health problems.

She told the newspaper that as this involves only small number of patients - 5% of all patients across the UK - it would not signal a move to before the 2004 contract, when GPs were frequently on-call at night or over the weekend.

Federations of 10 to 15 practices could come together to provide this care, and other professionals could also provide out-of-hours care, reducing the frequency of evening weekend work for GPs, she said.

She clarified this move would only be possible if 10,000 more GPs - the equivalent of one per practice - were trained.

In a statement sent to Pulse, a spokesperson for the RCGP said their upcoming report would suggest a range of ways of improving out of hours care.

They said: ‘Our document The 2022 GP - A Vision for General Practice in the future NHS, which will be launched shortly, 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.’

They added that major investment in primary care is needed, and that going back to before 2004 when GPs were working unsustainably long hours is ‘not an option’.

But the move was not welcomed by the GPC. GPC chair Dr Laurence Buckman said GPs do not want to take back personal responsibility for providing out-of-hours care and offering care for some patients and not others was ‘discriminatory’.

He said: ‘GPs don’t want to do that. It’s quite clear. To take it back for some and not others is unfair and discriminatory. How would you decide who gets care and who doesn’t? How would you justify this to someone who’s just missed the 5% test?

‘The conference of LMCs was quite clear that GPs do not want to take back personal responsibility for out-of-hours. That doesn’t mean we don’t want to organise it, and there may be GPs using power through CCGs who want to see better care through commissioning.

‘But I’d defy you to find many GPs who look at Professor Gerada’s proposals with enthusiasm. I’d be interested to see how many RCGP Council members back her on this.’

A DH spokesperson confirmed that health secretary Jeremy Hunt met with Professor Gerada on the 16 May to discuss out-of-hours care, but the RCGP denied they had met with the health secretary to discuss GPs taking back responsibility for providing round-the clock care.