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GPs should treat all unplanned admissions as ‘significant events’, says Labour review



GPs will have to treat all unplanned hospital admissions as ‘significant events’ under proposals being put forward by Labour’s healthcare commission.

The controversial suggestion forms part of recommendations developed for Labour’s shadow health team by Sir John Oldham, a GP in Glossop and the former efficiency tsar at the Department of Health.

The proposals focus on integrating the delivery of care in the community to avoid unnecessary admissions to hospital, which are similar to current developments being proposed by the Government.

But it goes further in suggesting that GPs should evaluate each unplanned admission to hospital, including readmissions, as a adverse events which they should learn to avoid in future.

The report read: ‘The NHS must also recognise the role of specialist expertise beyond the confines of hospital buildings; there is a need to deinstitutionalise our basic concept of health care delivery for whole person care to be achieved.’

‘This alignment to specialist knowledge with primary and community care must form a central part of whole person care, allowing for a greater focus of that specialist expertise on keeping the population well in their own homes rather than treating people once they require acute care. As part of achieving this we believe that GPs should view all unscheduled admissions, including readmissions, to be Significant Adverse Events, which need to be reviewed within a framework of continuous quality improvement.’

The review was set up in May last year to inform Labour’s health policies ahead of next year’s election and also recommends there should not be another major reorganisation of the NHS until 2020 at the earliest.

It recommends a ‘National Conversation’ is set up to outline legislative changes merging of health and social care budgets that would come into effect by 2020.

It said: ‘In our view, a new compact needs to be agreed with the citizens of the country. We argue that the vehicle to achieve this is an independent National Conversation looking at health and social care together, to be completed within 12 months of the next general election and with legislation enacted thereafter to enable implementation from 2020 onwards.’

In the interim, it recommends CCGs become more involved in primary care commissioning, something that NHS England has said it is already looking at.

It goes on to recommend that a form of scrutiny committee is set up, similar to the recommendations in the GPC’s plans for the future of general practice.

The report said: ‘While we believe that primary care should remain formally commissioned by NHS England, local arrangements should be developed to ensure the alignment of the commissioning for care. The nature of these arrangements are best determined locally, but may involve the development of joint committees between NHS England local area teams, CCGs, local authority commissioners and health and wellbeing boards to provide local scrutiny and oversight.’

‘Fundamentally, the commissioning of primary care needs to be aligned with local population needs in a commissioning system where health and social care are aligned and where “sense of place” determines the commissioning of services. We believe that these arrangements should be shaped in full to carry out this role from 2017.’

It added that financial incentives also need to be locally aligned, something which NHS England is planning to look at in an upcoming review of incentives.

The report said: ‘We also believe that financial incentives for GPs must be aligned with the outcomes required within the health and wellbeing board’s local collective commissioning plan.’