GPs were allowed to opt out of 24-hour responsibility after the introduction of the new GMS contract in 2004 which saw PCTs commissioning out-of-hours care, resulting in the expansion of private cover and dwindling of co-ops.
Speaking exclusively to GP, Professor Field discussed the wide-ranging review of urgent and emergency care in England announced in January and led by his boss Sir Bruce Keogh, NHSCB national medical director.
Asked what he would like to change, Professor Field said: ‘I think co-ops should be incentivised so that local GPs regain the ownership. But I also think we should be working much more closely with nursing and specialist colleagues.’
Rejecting criticism that this was a return to the past, he said: ‘The contract has perhaps run its course. You probably need to look now at how care is provided in a slightly different way for out of hours.
‘Now if you have a stroke in the majority of the country you go to a stroke centre. In 1982 I can remember visiting a farm and guiding the ambulance in to person who had a heart attack. Now GPs don’t go out for chest pain. The world has moved on. What is urgent care? What does out-of-hours care look like. How does it work with 111? How do you get local GP ownership?
‘I think we need to use incentives in a way to improve the quality and safety of care. I wouldn’t rule anything in or out. We should have a radical look at that.’
Asked whether GPs should be more active in managing patients in the community so emergency admissions reduce, he said: ‘I don’t think we should just be looking at GPs. It should be the primary care team. Involving patients, ambulance trusts, community nurses as well as GPs and might well include more outreach from hospitals for people with COPD using telehealth interventions.’
Asked whether the quality premium opened GPs to criticism that they were rationing services for personal gain, Professor Field said: ‘I think how it’s been sold certainly does. If we can work the profession there are ways of incentivising behaviours. QOF has now become such a tick-box system it disencentivises holistic care.
‘We need to have an adult conversation about how we use incentives, how we work across geographic areas with federations of practices, how we look at how community teams are trained and grow. There’s a great opportunity there.’
- Read GP’s full interview with Professor Field in the next edition dated 4 March.