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GPs urgently need better leadership on out-of-hours



If you are looking for a model case of how to turn a crisis into an opportunity, look no further than Jeremy Hunt’s response to warnings that A&E departments are on the verge of collapse. Whatever the rights and the wrongs of his analysis of the problem, he has successfully shaped a national debate that has as its starting point the assumption that GPs must take back some form of responsibility over  out-of-hours care.

With impressive political agility, Jeremy Hunt has effectively pre-empted the outcome of the NHS England consultation of urgent care;  as one national health journalist said to me this week, it is now a matter of how – and not if – the profession will take back out-of-hours responsibility in some shape or form.

 The very prospect is anathema for most GPs. A Pulse survey revealed earlier this month that most would not take back out-of-hours care ‘at any price’ – not even if there was a guarantee they would not have to do on-call shifts themselves.

NHS England has already responded to the health secretary’s call with a menu of options for improving out-of-hours care, most of which are at best unpalatable to GPs.

The response from GP leaders has so far been chaotic, with splits emerging at the highest level of the profession. The RCGP’s plan for GPs to take back 24/7 responsibility for the 5% of most vulnerable patients – immediately rejected by the GPC’s and hurredly clarified to no-one’s satisfaction – was clumsy to say the least. The resulting confusion must have been met with glee at the Department of Health.

Such divisions will only make it easier for a ‘solution’ to be imposed on GPs. So it is vital that the profession unites around an alternative vision of how to preserve better continuity of care out-of-hours, in an ever more fragmented NHS.

There can be no return to the days of being on-call and making clinical decisions on a few hours’ sleep.