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GPs should police out-of-hours care for the elderly, suggests expert group

GPs will have to ensure out-of-hours services for their most vulnerable elderly patients are of sufficient quality and easily accessible, under plans being discussed by an expert group advising the health secretary.

The group – convened by the NHS Alliance and attended by Jeremy Hunt – met yesterday and agreed the health secretary’s idea of a ‘responsible GP’ for all vulnerable older patients could be written into the QOF, or even put out as a local enhanced service for practices.

They agreed that out-of-hours services should be provided by GP co-operative groups wherever possible, with commissioners tasked with drawing up contracts that will prioritise co-ops.

The NHS Alliance organised the roundtable discussion at the behest of Mr Hunt, with the NAPC and clinical director at the Institute for Innovation, Dr Robert Varnam, who was there in a personal capacity, among those attending. The GPC was not invited to the meeting, although GPC member Dr Nigel Watson is attending in a personal capacity.

Speaking to Pulse, Dr Michael Dixon, chair of the NHS Alliance and the roundtable, said there had been a consensus from the 12 GPs present that the ‘named clinician’ plan was positive.

He said: ‘The responsible GP would be responsible for making sure the out-of-hours services are of sufficient quality and access through talking to the providers, as they have some influence.’

This responsibility could form part of the QOF, Dr Dixon added, or could be through a LES. He said: ‘My feeling is we have far too many targets in the QOF at the moment… We need to take this back a bit and create a QOF that removes some of that and replaces it with these concepts of having an accountable clinician and the service being sensitive to patients, and that sensitivity being part of the way we are paid as well. You could have a LES or a policy separate to the contract.’

However, the GP will not be responsible for providing out-of-hours services themselves – instead, that care would be best provided through GP co-operatives, Dr Dixon added.

He said: ‘We felt the co-op days were probably the halcyon days of out-of-hours provision and it should where possible be provided by local doctors who know the patients, not perhaps individually, but generically and the local services that are on offer and can avoid unnecessary hospital admission. They need to be very connected to the in-hours providers in a way that is not always the case at present.’

Although there is no way of having a ‘preferred provider’ under current arrangements, but the contracts could be written by commissioners in such a way that they prioritised these models, Dr Dixon added, echoing GPC’s comments last month.

He said: ‘You can make in your specification that there should be a percentage of OOH providers being local providers, you can make stipulations in the contract that make it more likely that a co-op model will get the contract as you can’t have a preferred provider in today’s model. But clearly some providers are more preferred than others.’

These plans would require more funding for general practice, and this was something that Mr Hunt understood, Dr Dixon said.

He added: ‘I think (Hunt) would like GPs to extend the work we do but he also totally realises that will require more resources. That is why he said 50% of doctors should become GPs and he certainly acknowledges that the flow of funding has been in the wrong direction for the past few years with much more going to secondary care than primary care.’

The round table took place on the same day that a landmark Government-commissioned report – led by patient safety specialist and former adviser to the US President Professor Don Berwick – recommended all patients should have a ‘named clinician’ responsible for their care at all times.