Beware plans to dump social care on GPs

Have you been inundated with requests for air conditioning from your patients or for anger management classes for little Johnny who refuses to stop pulling his sister’s hair?

It wouldn’t be much of a surprise if you had, given the coverage of the DoH’s ‘Commissioning Framework for Health and Wellbeing’ published last week, which concentrated on how GPs could spend NHS cash on non-medical services. The DoH described this as a radical new way of improving health and outcomes, but in reality it is a way of being ‘seen to do something’ by shoving yet more targets the way of primary care.

The framework is intended to deliver the promise of greater integration between health and social care — primarily by making more social care the responsibility of PCTs and GP commissioners. But it does so without giving due consideration to the fact that PCTs and GP practices are already over stretched.

Certainly there is no plan to invest heavily in this new approach. Yes, £8.9 million sounds like a lot — until you realise that it is to be divided between 81 designated areas. That means using the barely balanced budgets of PCTs or digging into the seemingly inexhaustible pot of savings supposedly generated by practice-based commissioning.

But, more importantly, delivering this latest set of objectives will use the other resources of practices — time and people. It is hard enough for GP practices to deliver existing targets, be it access, 10-minute appointments or the outcomes set out in the NSF for diabetes, without taking on housing and other social care issues.

Objectively, primary care is a focal point for many social care problems and it is understandable that government wants to tackle problems as directly as possible. But just adding to the responsibilities of practices is not a solution.

Instead, a radical shake-up of social care delivery with adequate resources and trained staff where the GP does not bear responsibility for an ever increasing raft of services (and associated blame) must take place before any solution is possible.

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