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NHS England to review RCGP proposals to take back out-of-hours care for vulnerable patients



NHS England will consider RCGP proposals for GPs to take back responsibility for the out-of-hours care of the 5% most vulnerable patients as part of its consultation on reforms to urgent care, Pulse has learnt.

The proposals for GPs to assume responsibility for 24/7 care for the elderly, those with complex medical problems and those needing palliative care or with mental health problems were not included in a recently announced public consultation on proposals for improving out-of-hours care services in England.

But the primary care lead at the body told Pulse that they were ‘interesting’ and that they would use them to inform their ideas on how to take forward Jeremy Hunt’s suggestion that ‘the buck’ should stop with GPs out of hours.

The GPC was intially enraged by the RCGP proposals, but this opposition was later moderated somewhat after the college subsequently clarified that it would like to see federations and co-operatives of GPs and other healthcare professionals providing the care.

Dr David Geddes, NHS England’s head of primary care commissioning, said its consultation document is only a ‘first stab’ at solving the issue, meaning the RCGP proposals would also be considered.

He said: ‘The RCGP is an important resource that we have and we don’t need [the proposal] to be published within the documentation. We work very closely with RCGP actually on how we will progress with thoughts. It is interesting information and evidence and we need to use that to inform the plan.’

Dr Geddes added that said the remit for 24/7 care could be included as soon as next year’s GP contract despite the consultation running into next year.

He says: ‘Discussions really need to be happening with the profession and within NHS England in order to understand what the priorities are, and what we can deliver. They are going to be quite sensitive to discussions.

‘We know there are a lot of concerns for the workforce of the profession so it is not something that we want to be taking unilateral action on.’

But out-of-hours experts said that NHS England was concentrating on the wrong things.

Rick Stern, chief executive of the NHS Alliance and a director of the Primary Care Foundation, which benchmarks out-of-hours services, said:  ‘There is a balance to strike because certainly continuity of care is something we all want as patients and what most GPs want to provide.’

He said many of the ideas presented so far are hard to see working in practice, but the solution may come from better use of technology, rather than GPs returning to 24-hour responsibility.

He explains the need to develop systems ‘whereby whoever may be dealing with the patient in the middle of the night can access the best possible information.

‘I don’t think anyone is seriously suggesting that all GPs should be on call all the time for their patients. We need doctors who work sensible hours and therefore are able to make decent decisions.’