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Don’t cut grassroots GPs out of talks on general practice reform, Nagpaul warns Hunt

The new GPC chair has warned ministers against marginalising the BMA as they draw up major reforms to primary care, and urged them to engage grassroots GPs as well as ‘enthusiasts’ and those representing ‘a small subsection’ of the profession.

Dr Chaand Nagpaul said the Government’s reforms would fail unless the majority of GPs were signed up to them, after health secretary Jeremy Hunt unveiled his latest plans for new GP responsibilites.

Yesterday Mr Hunt announced that he plans to change the GP contract to include a responsibility for practices to provide a ‘named GP’ responsible for coordinating all out-of-hospital care for vulnerable older people from next year. Mr Hunt discussed the proposals at a roundtable last month attended by GPs from the NHS Alliance and the National Association of Primary Care - an event to which the GPC was not invited.

Dr Nagpaul told Pulse: ‘One thing that I am trying to do is to get the Government to recognise that the changes that it wishes for depend upon the engagement of grassroots GPs, everyday GPs, the 95% of GPs who are not clinical leaders. GPC represents the body of GPs who are actually on the ground making general practice function on a daily basis - if the Government wants to achieve changes to improve general practice then GPC is the right organisation that it should be turning to.’

He added: ‘Changes to general practice can only occur through engagement with the vast majority of GPs via their main representative body, not via GPs representing a small subsection. This isn’t going to work based just upon the enthusiasm of enthusiasts. It will only work if you have sign-up and involvement of grassroots GPs, and that is where the GPC is the only legitimate body representing all GPs.’

Dr Nagpaul said the GPC did not disagree with the idea of GPs taking on a ‘named clinician’ role, but said he had yet to be told what exactly the plans would entail.

‘I think we need to understand what Jeremy Hunt means,’ he said. ‘The last thing we want is a box-ticking exercise of being a named GP as an end in itself. What matters is that patients receive quality, personalised care. Having a named GP as an end point doesn’t deliver that. What is really important is that patients can get personalised care from the right professional which in many cases will not be the GP, for example on the weekend.’

Dr Nagpaul also warned that Mr Hunt’s plan would require a shift in resources.

He said: ‘At the end of the day it is a core duty of GPs and a part of our work to look after vulnerable patients but we need to be enabled and given the breathing space and the time and resources to look after patients in the way that they deserve.

‘What we need to do is reduce some of this pressure on GPs and a part of that will need to be to reverse some of the damaging effects of the [contract] imposition, so we want to reverse some of the imposition changes. There needs to be a proper dialogue of how general practice can be expanded to have the infrastructure to provide this expanded model of care. That is the dialogue that needs to occur. So the concept is fine but it is not going to be possible until we address the obstacles of workload pressures and actually expand general practice.’

The Department of Health was last night tight-lipped on the detail of Mr Hunt’s announcement. It failed to invite Pulse to a DH press briefing held yesterday to explain the plans, and DH officials declined to give more details on what ‘named GPs’ would be expected to do or how the additional work would be funded until after a public consultation on the care of vulnerable patients ends on 27 September.

But GP leaders at the NHS Alliance and NAPC suggested some of the additional work could be funded by a shift of resources from the QOF, which is widely expected to be shrunk as part of next year’s contract negotiations.

NAPC chair Dr Charles Alessi said: ‘The named clinician is essentially what general practice should be all about, which is a sense of community and ensuring population health. But for that to happen we will have to remove a lot of bureaucracy from general practice including parts of the QOF. We have been encouraging a decluttering of primary care so that GPs can deliver this.’

‘We support this as part of a package of changes, because on its own it is not going to work.’

Dr Michael Dixon, chair of the NHS Alliance, added: ‘I think that there is a recognition that general practice is under a lot of pressure and Jeremy Hunt will want to ensure resourcing of his particular priorities of having accountable GPs and looking after vulnerable elderly.’

‘I think what [Mr Hunt] is suggesting is that in order to focus on these things we will need to quite radically reduce what is in the QOF so that releases time and resources to these new imperatives.’