A DH summit held on Wednesday was attended by NHS England’s deputy chief executive, Dame Barbara Hakin and senior officer for 111 John McIvor as well as BMA representatives.
GPC out-of-hours lead Dr Peter Holden, who was at the meeting, said officials were listening to BMA proposals and there was agreement that 111 should be exempted from competitive procurement and integrated with the provision of other unscheduled care services.
The proposals could see ministers change regulations to allow commissioners to exempt 111 services from competitive tendering.
‘How can you run an A&E service if below that is a system which is totally and utterly free-market?' said Dr Holden. ‘I think [officials] have all agreed they need to listen and re-engineer.’
The summit came the day before the GPC published its proposals for urgent care services as part of its Developing General Practice today policy document, which calls for integration of all unscheduled care, including GP out-of-hours care, NHS 111, and hospital emergency departments.
The GPC report said all urgent care services should be removed from competitive tendering to enable commissioners to select services based on patient safety and resource efficiency.
Dr Holden, speaking after the DH summit, said officials were ‘in listening mode’ and ‘genuinely looking for new ideas’.
‘What was unanimous was that the procurement of 111 should be by statute rather than by contract. Because that way you get a unified service, right through A&E, through hospital, and out. Because this is about the whole urgent, emergency and unscheduled care programme. The key point is a CCG can then pick the clinically best deal, rather than be compelled to take the cheapest deal.’
‘Frankly’, added Dr Holden, ‘if that upsets [the commercial providers], then so be it; they never should have got in their hands on it anyway.’
GPC member and CEO of Badger out-of-hours service in Birmingham Dr Fay Wilson said competitive tendering ‘casts a blight’ on services, and was the most important issue for urgent care.
‘It means there are short-term contracts driven by price with no long-term investment, and a disintegration of services.’ But she warned that integrating all urgent care would not be welcomed if it meant handing control to foundation or ambulance trusts.
The new GPC document also calls for a minimum staff-to-population ratio in out-of-hours provision and contracts based on a provider’s experience and expertise, and for 111 triage to be clinician-led.