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NHS England rejects GPC’s alternative proposals for out-of-hours care

Exclusive NHS England has rejected GPC proposals to give ‘preferential treatment’ to GPs who decide to opt into providing out-of-hours care to their patients, saying the move would not be allowed under current procurement rules.

The response comes after the GPC published its full alternative proposals for a reorganisation of out-of-hours care yesterday that suggested GPs should be considered the preferred provider if they wanted to take back responsibility for out-of-hours care.

GP and CCG leaders have backed the ideas in principle, but NHS England said that current procurement rules ‘would apply’ and that favouring GPs over other providers would be impossible.

The response is a blow to newly elected GPC chair Dr Chaand Nagpaul, who first disclosed GPC’s alternative plan to Pulse last week.

NHS England has said it will be taking forward the health secretary’s call for contractual changes to force GPs to take back some sort of responsibility for their patient’s care out-of-hours.

In response to the GPC’s plans, a NHS England spokesperson said: ‘CCGs already have the responsibility for ensuring out of hours contracts are working effectively, taking any necessary action where a service provider is not performing to the specification in the contract.’

‘Where a provider is consistently not fulfilling their duties under the contract, the contract will set out the actions that can be taken by the commissioner. This is likely to include early termination.’

‘There are no rules to prevent GP practices from seeking to work together to provide an effective service out of hours. Current procurement rules would apply and would mean that they would not have any preferential consideration above any other potential provider.’

GPs in Hackney have already been blocked from taking back out-of-hours care from a private provider due to competition rules, despite winning the support of the health secretary who told them to ‘be brave’.

Dr Michael Dixon, NHS Alliance chair and acting president of NHS Clinical Commissioners, said he supported the plans.

He said: ‘I like for instance the steer that where an out-of-hours provider is committed to a high density of local GPs, they should have preference. I think that is a very good idea. Obviously within reason, and costs and all the rest of it, but we know that those co-ops which do involve local GPs in out of hours - like my own in Devon - do seem to score the best.’

‘We also know that there has been a big problem in out-of-hours when doctors have come from elsewhere, from different countries, and weren’t fully acquainted with medicinal practice here or the patient population. If you have a doctor who knows the local nursing homes, care homes, district nursing system and the rest of them then - all things being equal [between them and a competing bidder] - they are more likely to be able to keep the patient in the community rather than call and ambulance or send them to hospital.’

Dr Dixon was also in favour of the GPC’s proposals to integrate the running of existing urgent care settings, such as walk-in clinics and A&E minor injury units, as well as 111, for example via block funding.

He said: ‘I think there is a lot to be said for that. They need to be integrated, they need to work together and I think at the moment a lot of the CCGs are looking at the value of some of the services they are offering, like walk-in clinics.’

The Family Doctor Association also backed the proposals. Its chair Dr Peter Swinyard told Pulse: ‘I have read the full GPC paper and think it excellent – I would support both its contentions and direction of travel fully.’

GPC chair Dr Chaand Nagpaul said: ‘We believe that this is an unnecessarily expensive and bureaucratic process to force CCGs to open this to competitive tendering. Our view is that in many instances where a GP out-of-hours service is provided by local GPs within an integrated framework, that would not lend itself to competitive tendering or procurement.’

‘I am pleased that the proposals are well received by other GPs and colleagues. We do believe that these proposals form a basis for moving forward with the commissioning of out-of-hours services.’