Hunt's 'radical' GP overhaul sets scene for contract clash

GP contract talks for 2014/15 look set to become a battle to avoid a further contract imposition after BMA and RCGP leaders hit out at DH reform plans.

Jeremy Hunt: primary care reforms
Jeremy Hunt: primary care reforms

One GPC negotiator warned plans to make named GPs responsible for patients' health and social care around the clock were ‘unworkable’ and based on a ‘1950s view of general practice’.

Health secretary Jeremy Hunt warned in a speech at The King’s Fund think tank on Thursday that the NHS would become unaffordable without ‘bold and radical’ changes to care outside hospital.

He set out plans that could hand back out-of-hours duty to practices, called for a ‘dramatic simplification’ of targets and incentives for GPs, and pledged to shift hospital savings ‘back into general practice to pay for higher levels of care’.

Same-day access to GPs could also feature in the overhaul, after NHS England medical director Sir Bruce Keogh revealed this was a theme emerging in his urgent care review.

Full detail of how the proposals will be implemented will be worked out in negotiations later this year, Mr Hunt said. But the health secretary said he was confident the changes would be in place by April 2014.

Although senior GPs at the National Association of Primary Care, NHS Alliance and Family Doctor Association welcomed the government’s efforts to help patients have ‘a personal and continuing relationship with a named GP’, both the RCGP and BMA have criticised the plans.

GPC negotiator Dr Dean Marshall hit out at the lack of detail in the proposals, and urged ministers to stop announcing policy without talking to the profession's representatives.

‘GPC is the only representative body of GPs,' he said. ‘If anything is going to be discussed with the profession, we are the body. If they involved us in the planning stage we might be able to stop them making statements they can’t actually back up.’

While the GPC was not necessarily against the principle of named clinicians, Dr Marshall said any legal or contractual consequences would cause ‘major problems’.

It was unclear if GPs faced another contract imposition, he said. But he added: ‘Ministers can announce what they want, but until they accept we are in a crisis, it’s not going to improve.’

RCGP chairwoman Professor Clare Gerada also said it was unclear how the plans would work in practice. ‘We would say, it is far better to look at a micro-team of individuals who are the named team,’ she said. But what was needed first was a massive new investment in primary care, she added.

NHS Alliance GMS/PMS lead Dr David Jenner warned that 'good ideas without detailed implementation plans and no consultation with the profession had a long track record of ending up on the scrap heap'.

He pointed out that if GPs were to be made responsible for patients' health and social care they would need authority over social care staff and budgets. 'I don't see that happening,' he said.

He warned that any move to slim down the QOF or simplify funding by limiting enhanced services must not translate into an attempt to re-badge funding practices already receive to pay for extending their role.

'Redefining money from QOF does not give GPs more cash or staff,' Dr Jenner warned. 'What general practice needs to take on the extra responsibility for this is a period of stable funding with more on capitation and less on bits and bobs like the QOF and enhanced services. The idea needs a plan to support it and Mr Hunt and NHS England need to agree it.'

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