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Time to spit it out Mr Hunt. Just what are you asking GPs to do – and how will you pay for it?



It feels like we’ve been here before. An opening salvo of pre-briefings at the weekend. Ominous rumblings from the Department of Health. A series of critical articles as the week progresses, leading up to a heavily-trailed keynote speech by the health secretary on Thursday.

Jeremy Hunt clearly felt the launch of his out-of-hours plans went so well back in May that he’d use the same template again when talking about elderly care. He’s even giving the keynote speech in the same venue – the King’s Fund.

And yet while in PR terms both launches have been an unqualified success – headlines have been generated, GPs duly bashed – the practical implications of both policies still remain entirely unclear.

In his announcement yesterday, Mr Hunt made it clear that he expects ‘named GPs’ to take on 24/7 responsibility for coordinating all of the out-of-hospital care for vulnerable older people. He expects it to happen as soon as next April, and he plans to change the GP contract to make it so. And… well, that’s all we really know.

What exactly will this ‘named GP’ responsibility entail? What will patients be told they can expect? What extra work will it involve? How does it differ from what many practices already provide? Does it simply mean a return to personal lists – and if so, why will it only initially apply to around 5% of patients?

And crucially, with practices already stretched to breaking point, how will it be resourced, if at all?

The Department of Health is keeping schtum on all of the above (it claims it can’t set out its plans until a public consultation on the care of vulnerable patients ends on 27 September, although that doesn’t seem to have deterred Mr Hunt). So for the time being GPs – and, worryingly, even the GPC  – have been left in the dark, left to second-guess how the policy will actually impact their day-to-day jobs.

But it’s not just the ‘named GP’ proposals. Back in May, after the week of out-of-hours rhetoric, I wrote a blog post attempting to summarise what we knew so far about Mr Hunt’s out-of-hours plans – and worryingly, we don’t seem to have any more detail on those yet either. They are, it seems, linked to the plans to improve elderly care, but exactly how remains unclear. We still don’t know how GPs will be held responsible for out-of-hours care. We still don’t know what levers they will be given. We still don’t know how what Mr Hunt envisages differs from the commissioning responsibility GPs have already been given. And we still don’t know how the additional responsibility will be funded.

There are two schools of thought among GPs about what this all adds up to. Some, including, for example, Londonwide LMCs chief executive Dr Michelle Drage, believe Mr Hunt sees the PR battle as an end in itself. Talk tough to the Daily Mail, be seen to ‘sort out the 2004 contract’ and score a political victory.

Others fear the reforms are much more real – that while we haven’t yet heard the detail, combined with NHS England’s wide-ranging plans to shake up practice funding they add up to a brand-new GP contract in the near future.

The truth is, we still don’t know. But in the meantime, GPs are left in limbo, and increasingly anxious as ministers ratchet up the rhetoric.

Mr Hunt may be, unlike his predecessor, stronger on the politics than on the policy, but he can only keep dodging the practical questions for so long. It’s time for the Department of Health to draw a line under a summer of sabre-rattling and set out what it actually plans to do. Sooner rather than later would be good.

Steve Nowottny is the editor of Pulse. You can follow him on Twitter @stevenowottny.