Wednesday 5 June 2013

GPs' leader looks to end out-of-hours care row

GPs' leader looks to end out-of-hours care row: Dr Clare Gerada, chair of the Royal College of GPs, wants family doctors to take back responsibility for key groups of patients.
The leader of Britain's GPs has offered ministers a way out of the impasse over out-of-hours care by proposing that family doctors take back round-the-clock responsibility for some heavy users of NHS services.

Dr Clare Gerada, chair of the Royal College of GPs (RCGPs), wants GPs to once again be in charge of the care at all times of key groups of patients who, though small in number, take up a disproportionate amount of the NHS's time because of their precarious health.
GPs should become the leaders of new teams who would help the frail, elderly, patients at the end of their lives, those with complex medical problems and patients with certain mental health problems, she told the Guardian in an interview. In all, GPs would become responsible for the daytime, overnight and weekend care of about 5% of patients across Britain, she added – about 3 million people.
Gerada's plan could help relieve the growing crisis overwhelming A&E units by ensuring that these frequent users of NHS services are better cared for in their own homes by teams comprising community nurses, pharmacists and physiotherapists as well as GPs. "GPs want to and should be the medical home for patients. GPs reduce health service costs, improve outcomes and provide better patient experience. We need to find a way of providing personalised care to those patients that need it most – and ensure that they receive continuity in and out of hours, in and out of hospital," she said.
The proposal was welcomed late Tuesday by Jeremy Hunt, the health secretary, who has found himself in a bitter dispute in recent weeks after suggesting that GPs should take back responsibility for the round-the-clock care of all patients, which they had until this duty was lifted in a deal with the then Labour government in 2004.
"I welcome the RCGPs decision to look at the issue of out of hours care and agree with their direction of travel. This shows that Labour are wrong to defend their 2004 GP contract which has done much to undermine the public's relationship with their GP," Hunt said.
Department of Health sources said discussions had already taken place with the RCGPs about the ideas, which they called "interesting proposals".
Gerada outlined her plans in an interview about out of hours and the future roles of GPs in the NHS.
But, mindful of huge opposition among GPs to go back to the situation pre-2004, where their lives were disrupted by regularly having to do house calls overnight, Gerada stressed that her proposals would only involve family doctors looking after a small number of high-risk patients. Groups or federations of 10 to 15 GP practices could come together and provide between them what she called "bespoke enhanced care to those that need it most", and thus reduce the frequency of having to work overnight and at weekends, she said. The other care professionals in high-risk patients' care teams would also provide a lot of the out of hours care, Gerada added.
"This is not about GPs retiring to take over provision of [all] out of hours [care]. It's about finding a middle way of [GPs] providing, with others – such as primary care nurses and pharmacists – bespoke enhanced care to those that need most", she said.
But, she warned, for the plan to work it would need an extra 10,000 GPs to be trained and employed in order to boost the UK's 36,000-strong primary care workforce – about one more GP for each practice.
However, there were already signs that Gerada's intervention could split GPs and lead to tension between family doctors' professional body, the RCGPs, and the British Medical Association (BMA), the doctors' union. Dr Richard Vautrey, deputy chair of the BMA's GPs committee, rejected Gerada's plans. "If GPs took back responsibility for 5% of patients there would inevitably be pressure for it to be 100% of patients, and GPs are adamantly opposed to that. GPs will oppose her suggestion as a slippery slope. GPs are overwhelmed by their current heavy workload and long working day with as many as 50% showing signs of burnout. Even the thought of working yet longer hours on evenings and at weekends would be enough to make many GPs consider their future in the profession" The Guardian

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