Interview: Primary care faces hard road ahead, warns Labour peer

GPs cannot be blamed for A&E problems, but primary care reform is inevitable, Labour peer Lord Hunt tells Neil Roberts.

Philip Hunt, Baron Hunt of Kings Heath, began his long association with the NHS in the 'worst job in the world': a works study officer, following hospital porters around with a stopwatch.

'It certainly gave me an insight into the pressures on staff,' says the Labour peer, health spokesman for his party in the House of Lords.

He moved on to hospital administration and community health councils, was director of the National Association of Health Authorities and Trusts, and then became the first chief executive of the NHS Confederation.

Two years after being made a life peer in 1997, he became parliamentary undersecretary of state for health. He held the role until resigning in protest at the Iraq war in 2003, before returning to Labour's health team in 2007.

Out of hours

Lord Hunt's current boss, shadow health secretary Andy Burnham, was quick to defend GPs in their row with the government over out-of-hours care and pressure on A&E - not least because health secretary Jeremy Hunt put Labour's 2004 GP contract deal in the frame.

Lord Hunt condemns Mr Hunt's 'vitriolic attack' on GPs. 'It's really quite unnerving,' he says, 'and I think quite insulting to GPs to single them out and seem to blame them for a service that is under huge pressure because of the funding situation, reductions in social care, and the fact that we've spent the last three years worrying about this ludicrous reorganisation.'

He says it was a Conservative government in the 1990s that took the first steps to relax GPs' 24-hour responsibility, and defends the 2004 deal as a reflection of the workload GPs could take on.

The real problem now, says Lord Hunt, is that people have lost confidence in GP out-of-hours care. The combination of the 'disastrous' NHS 111 implementation and problems accessing services is increasing pressure on overstretched A&E departments, he says.

But he agrees with the government that out of hours should preferably be 'GP-led', without forcing GPs to take on impossible workloads.

There could be a greater role for primary care in emergency departments, he adds; a solution that was recently proposed by the College of Emergency Medicine.

'What we can do to improve out of hours is get GPs much more involved in A&E,' he argues, demanding 'radicalism' in planning for future service provision.

Mr Hunt's outline plan for 'named individuals' responsible for all of a patient's primary care has received qualified support from the RCGP.

But Lord Hunt dismisses the proposal. 'That's what I call a ministerial announcement of the day, which I suspect will die a death,' he says. 'The question is, how will that operate 24/7 and what is the cost? Of course, we'd all like a named person we can always go to, but I wonder about the practicalities of it.'

Lord Hunt is clearly proud of his background in the health service, something he believes would benefit all NHS leaders, giving them a better understanding of patients' perspective.

Although Lord Hunt was a well-known figure in the NHS, in 2003, the then deputy prime minister John Prescott claimed never to have heard of him when he was one of the handful of government figures to resign over the war on Iraq.

Healthcare reforms

Earlier this year, Lord Hunt was making headlines spearheading Labour's failed attempt in the Lords to derail the government's Health and Social Care Act, in particular the so-called section 75 rules on competition and tendering.

He condemns the regulations as promoting 'marketisation', forcing commissioners to 'parcel up' services and put them out to tender, and destroying any hope of developing integrated care.

Labour has been pushing hard in recent months on health and social care integration and its 'whole person care' approach. Lord Hunt says primary care is key to this vision and ought to be the foundation of an integrated system.

But GPs will want assurances that integration and moving care from hospitals into communities will not accelerate the trend of ever-greater workloads and ever-dwindling resources for them.

'You have to combine resources' across primary and secondary care, argues Lord Hunt, and invest in community facilities before hospitals start closing wards, which is ultimately 'the only way you can transfer money' out of secondary care.

Federated practices

Echoing concerns within general practice over competing demands from society, Lord Hunt says there could be an increasing need for practices to federate.

'There are big questions for the profession. I see a real tension in terms of what the public want.'

Working age people 'probably know what's wrong and you want very quick access', he says. 'If you are an elderly, frail person, you often value the continuing care good general practice can give, with people you know and trust.

'Inevitably that makes you look at the size of practices, or whether they need to federate more. There are some big challenges,' he says.

If Labour wins the next general election, GPs will hope Lord Hunt's early NHS experiences will help him understand the pressures practices now face.

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