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GPs couldn’t really be forced to take back out-of-hours responsibility… could they?



Four weeks ago, Pulse first reported that Jeremy Hunt had decided GPs were to blame for the current intense pressure on A&E, after a series of remarks he made in an otherwise uneventful health questions in the House of Commons. 

At the time, the Department of Health was furious with our story, angrily insisting that Mr Hunt was not in fact blaming GPs, merely criticising the 2004 GP contract negotiated under a Labour government (though quite how Mr Hunt’s attack on ‘poor primary care provision’ was not an attack on GPs themselves was never quite clarified). 

Four weeks on, with the story very much front and centre of the national media agenda, no one would dispute that it is principally GPs who are getting it in the neck for the problems in A&E, and that GP out-of-hours services are coming in for a pasting.  

A clamour of criticism has risen to a crescendo this week with back-to-back Daily Mail front pages attacking out-of-hours care, fresh headlines this morning off the back of a College of Emergency Medicine report into A&E pressures and national newspaper columnists getting the bit between their teeth. (The Telegraph’s unfavourable comparison of GPs to vetsyesterday may generate the most outrage in practices, but it is the piece in today’s Times, headlined ‘GPs must work harder – it’s an emergency’ and written by the well-placed Alice Thomson, which is probably the more ominous.) 

What is all this building up to? Well, Mr Hunt has been very careful to commit to nothing explict, but the signs all seem to point in the same direction. Later this month NHS England medical director Sir Bruce Keogh will present a wide-ranging report on the future of urgent and emergency care, which will specifically consider the possibility of GPs taking back responsibility for out-of-hours care.

The recommendations of that report, it’s important to stress, are by no means a foregone conclusion. In my interview with him at Pulse Live, NHS England chair Professor Malcolm Grant played down the prospect of GPs taking back out-of-hours care. Nor do NHS England’s planned changes to the GP contract which we reveal today necessarily seem to align with the idea.

GPs, too, might have a little something to say about it. As Copperfield made very clear yesterday, there is probably no single action the Government could take which would more radicalise weary grassroots GPs than forcing them to take back out-of-hours. Older GPs still remember the bad old days – whole weekends on call, wives and husbands on phone-answering duty, peering at house numbers at 3am in the morning. Pensions didn’t do it, and the NHS reforms didn’t either, but force GPs to work the night shift again and you suspect many really would vote with their feet.

And yet… Mr Hunt has shown little sign to date of being overly concerned about his popularity among GPs. There are massive questions over how returning out-of-hours care to the profession could possibly work in practice – would it mean a return to co-ops? – but in the broader scheme of things, the practicalities are almost beside the point.

With the support of the national media and a general public already anxious over out-of-hours care thanks to the 111 debacle, unpicking the 2004 contract is an idea which seems to have the wind behind it.

Whether it would really solve the A&E crisis is open to debate; whether GPs have the capacity to absorb more work or the willingness to return to 24/7 responsibility is extremely doubtful. But unlike his predecessor, Mr Hunt is an extremely sharp political operator. And right now it’s looking like smart politics.