GPs should be allowed to opt-in to providing out-of-hours services and should be given ‘preferential treatment’ to other providers if they do, the GPC has proposed as it publishes its full plans to revamp out-of-hours care.
In its first comprehensive proposals to rebut the Government’s plans out-of-hours care, the GPC cited areas where GPs had been prevented from providing out-of-hours care, despite wanting to, and said any new system should allow GPs to opt-in when they wanted to and be the preferred provider over private companies, for example.
However, the policy document also emphasised that GPs must retain the right to opt out of directly providing out-of-hours care, warning that any attempts to push through compulsory responsibility would result in ‘immediate retention problems’. It also said no changes to the current contract were necessary.
The proposals come as part of the GPC’s alternative plans for out-of-hours reforms that rebutts a series of Government calls for GPs to become the ‘named clinician’ for their patients 24/7 and taking on responsibility for ‘signing off’ all their patients’ out-of-hours treatment.
The document said: ‘Changes to the GP contract are not required to secure improvements in out-of-hours care. We are willing to engage in discussion about improving out-of-hours provision and increasing the influence GPs have on commissioning and designing these services, but this should not be frame as GPs “taking back” out-of-hours care. Any attempt to push this through would be likely to result in considerable recruitment and immediate retention problems.’
But the GPC said that to take on more responsibility GPs must also be given ‘real power’ over commissioning via CCGs, including GP review of existing contracts ahead of their expiry date.
‘Preferably, changes should go further by giving preferential treatment to local practices and GP-led organisations that want to be involved in out-of-hours care to be able to do this. Practices should be given the right to opt back into out-of-hours provision individually or collectively where they express a desire to do so (as recently in Hackney), alongside the existing right to opt out,’ the paper said.
As reported by Pulse, the GPC wants to integrate the fragmented urgent care system, including tying together the 111 call-handling service with all other urgent care services on the ground locally, such as the GP out-of-hours service, walk-in centres and A&E minor injury units. This could be done via a redesigned tariff or block funding method, the paper said.
It said: ‘The urgent care system has become highly fragmented and confusing for patients. To avoid duplication and make access points more obvious to patients, robust CCG-led commissioning should integrate the health services involved in out-of-hours unscheduled care including telephone triage and advice, primary medical services out of hours, walk-in centres, “Darzi” clinics, NHS 111, A&E tier 2 services and even some parts of the 999 service. The service should also have close links with community nursing, hospice care, pharmacy and social services.’
‘Consideration needs to be given to pricing structures in the system to enable this. A redesigned tariff or block funding method for the whole system could help providers work together more closely.’
To do this effectively, and to make the use of urgent care efficient, the 111 service must also be led by GPs rather than lay call handlers, the GPC paper added.
The paper said: ‘Triage of patients is a skilled activity and should be undertaken by the most skilled and experienced clinicians available to allow the handling of large volumes of work with accuracy and speed and executive authority, not by untrained lay people – even when supported by a computer algorithm.’
‘Non-clinical or inexperienced call handlers are forced to rely on risk-averse software which can escalate the level of response and so undo any predicted cost benefit.’
It added that managing demand would be a key challenge and called for better health education in schools to support this, as well as the setting up of appropriate care plans for the most vulnerable patients, to be managed by their carers rather than their GP. It further tentatively suggested that CCGs could be made responsible for provision as well as commissioning of out-of-hours care but said this suggestion required further discussion.
The paper said: ‘Ultimately, it may be worth allowing CCGs to become the providers as well as the commissioners of out-of-hours services. This is a matter for further debate, though David Nicholson, the chief executive of NHS England, has stated that the integration of commissioning and provision will be considered against particular sets of challenges.’
The GPC position paper reflects where the GPC stands on the issue of out of hours only, but was informed by a roundtable discussion also featuring the RCGP, the Patients Association, NHS Alliance, the BMA’s consultants committee and a community healthcare trust medical director.