GPs will have to be available 24/7 to offer ‘decision support’ in order to prevent patients from being admitted to hospital under a plan to radically reform the urgent care system published by NHS England today.
The move is proposed as part of a package of suggested measures to improve the care of patients seven days a week, including holding GP telephone consultations out-of-hours’ and a guarantee that patients can have ‘same-day access’ to GPs who are ‘integrated with their GP practice’.
NHS chiefs said that they did not ‘necessarily’ want GPs to be on-call 24/7, but that they wanted to create a more ‘integrated’ system.
The document proposes that patients should be given ‘guaranteed same-day access to a primary care team that is integrated with their GP practice’, possibly through ‘GP telephone consultations both in and out-of-hours’.
It also proposes that GPs or out-of-hours teams should have ‘easy direct access’ to a same-day opinion from hospital specialists.
But what is likely to be one of the more controversial suggestions is to provide: ‘decision support from a patient’s own GP practice and hospital specialist nurse/team, seven days a week’.
Other suggestions to improve urgent care include having urgent care centres staffed with a ‘multi-disciplinary team with support of at least one GP or other registered medical practitioner’.
The proposals come after Pulse revealed that seven in ten GPs would not take back responsibility for out-of-hours care even if they were offered up to £20,000 per partner and had a guarantee they would not have to do the on-call shifts themselves.
The chair of the consultation process, Professor Keith Willett, NHS England’s director for acute episodes of care, told Pulse: ‘What we want to avoid is patients seeking urgent healthcare on the weekend or in the evening, and the person who is there not being able to access the medical information or advice that is critical to making the decisions, and therefore ultimately ends up in an avoidable transfer to hospital.
‘So what we’re talking about is not necessarily GPs being on 24-hour call, we’re talking about making sure the system is integrated. So that whether it is the out-of-hours GP, or whether it is the paramedic at the scene, or the GP seeing the patient at home that they can access the information they need, and that they can call on hospital specialist advice if that is all they need, rather than having to default to a transfer to hospital.’
He added: ‘Going back to the initial question of what is it like for the person who stands next to a patient with complex needs. Can they draw on advice from general practice, expert advice from the hospital, can they draw on the social services and directorate services that may contain the patient at home, with support.’
Asked whether NHS England would consider shifting more funding into general practice to support them doing more work out of hours, Professor Willett said: ‘The outcomes of the review are awaited and if that is what people think is the right thing to do then certainly all of those are possibilities.’
Following the consultation, which will be open to the public and NHS staff from 17 June to 11 August, the Urgent and Emergency Care Review will develop a national framework and associated guidance for CCGs in 2015/16.
BMA char Dr Mark Porter cautiously welcomed the review.
He said: ‘This review recognises the complex pressures on urgent care and as such is more likely to produce sustainable solutions. Spending on healthcare is squeezed, patient demand is rising and staffing levels are inadequate. The Government’s failed implementation of NHS 111 has only heaped more pressure onto an already stretched system.’
‘So far the Government’s response to this has been overly simplistic, with the blame being put squarely on individual parts of the health service.’
‘Emergency care providers are facing high levels of demand that are only going to increase in the years to come, and become more complex as the population grows and people live longer. We look forward to working with the review team to find a solution that enables NHS services to work together to provide the appropriate access to the care patients need.’