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General practice is in a state of ‘crisis’, says senior GP commissioning leader

Exclusive: General practice is in a state of ‘crisis’ and requires additional funding to take on more responsibility, claims NHS Clinical Commissioners interim president Dr Michael Dixon.

In an exclusive interview with Pulse, Dr Dixon said that extra resources are needed in primary care and that this was the only way that GPs could help alleviate the current pressure on emergency services.

Dr Dixon said the health secretary’s comments that relinquishing responsibility for out-of-hours care was behind the pressure on A&E departments were ‘disingenuous’.

His comments come after NHS England suggested GPs could be asked to provide 24/7 ‘decision support’ in order to prevent patients from being admitted to hospital. A recent Pulse survey showed that seven in ten GPs would not take back out-of-hours care ‘at any price’.

He said: ‘I think there is an A&E crisis but I think there is also a crisis in general practice and primary care. There is a crisis of recognition and funding. Last year, the funding for secondary care went up by 1.4% at a time when funding for general practice went down by 1.4%.

‘There are as many GPs now in my area as when I started 30 years ago, while the number of consultants has doubled. But during that time the amount of work we do and the amount of areas we cover has vastly expanded… without extra resources.

‘To blame us for the increased number of people going into casualty departments I think is disingenuous because we are now many years after the [2004] GP contract came in.’

But he added that GPs could help alieviate the pressure on A&E deparments if they were adequately funded.

He said: ‘We can offer more minor casualty work for instance in general practice, and if we make ourselves more accessible for same-day problems I am sure we can help. I don’t think we are the main cause of the problem having got to crisis point. But the question is, are people willing to put the resources there for general practice to actually take on these responsibilities? I hope they will do. I hope the CCGs will do, I hope that NHS England, holding the primary care contracts, will but unless that happens our hands are tied.’

Dr Dixon said the time has now come to invest in primary care contracts to allow GPs to help solve the wider crisis in the NHS.

He said: ‘GPs already do help an awful lot and £120/year per patient is a very small amount to pay for what we do already. There is no doubt GPs already are preventing an awful lot of people going into casualty. Not to mention that… we are looking very closely at our use of resources so that we can make the NHS go that bit further but you only get what you put in and at some point you have to put more in to get more out.’

Meanwhile, he said that while integration of health and social care has to happen, this should be left up to the new commissioners to bring about without further organisational reform – as has been proposed by the Labour Party.

Dr Dixon said: ‘We have to make bold moves if we are going to let general practice really take this forward [but] I think we do not need organisational change, in fact I think we need it like a hole in the head. I think integration is what we do need… but we must now allow our commissioners to bring that about. We can’t start to say this is the organisational form it will take or this is when it needs to be done.’

Dr Dixon, who was speaking to Pulse at a College of Medicine conference focused on self care, also said that in order for the health service to be sustainable in future, GPs would have to do their bit to encourage patients to self care more for their conditions.

He said: ‘I think we can really push the boat out now in terms of making whole communities far more resilient in how they treat minor illness, how they approach even major illness, and the extent future care can be a cooperative effort between clinician and patient, not just the GP telling the patient.’