Future NHS must be built on 24-hour primary care, says Alliance

The NHS should rebuild around a 24-hour primary care system led by GPs who control local out-of-hours services and are backed by community-based consultants, an NHS Alliance report argues.

Dr Michael Dixon: hospitals can be dangerous places
Dr Michael Dixon: hospitals can be dangerous places

Breaking boundaries, billed as a ‘manifesto for primary care’ argues that general practice must retain its best elements - ‘personal, holistic and continuing care’ but increasingly expand to offer ‘diagnostic, outpatient-type services’.

The report attempts to tackle the question of how to maintain a publically funded NHS when ‘money is tight, demand is rising and public expectations are changing’.

Rising to this challenge will have ‘profound implications for the way health and social care is organised and delivered’, the report warns.

NHS services must be better integrated, and care delivered in hospitals only as a ‘last resort’.

NHS Alliance chairman Dr Michael Dixon warned: ‘Hospitals can be dangerous places.

‘If we are to put people before numbers and achieve high quality of care, while also achieving the efficiencies required to sustain a long-term NHS free at the point of need, there is an immediate imperative to shift all non-urgent care from the hospital to the community.’

The report calls for sweeping changes to hospital and primary care funding to pay providers ‘for service, rather than activity’.

The report calls for '24/7 primary care' and a rethink on the separation of in- and out-of-hours GP services, with local GPs given the right to run out-of-hours care if they wish. More GPs should be supported to work in out-of-hours care in addition to in-hours care, it adds.

Primary care clinicians should be paid to work with local councillors and populations, using NHS data and local knowledge to improve ‘overall local health’ by tackling problems with housing and other social issues that can undermine health.

The integrated NHS system should find ways to pay doctors to keep patients out of hospital, with all unscheduled admissions triggering an ‘analysis of cause’.

GPs should work with hospital specialists to develop ‘joint rotas’ that underpin the provision of 24/7 NHS services, the report says.

Consultants should be freed from contracts that tie them to working in specific hospitals, to allow them to be ‘community-based by default’. Their contracts could be held by CCGs or the NHS Commissioning Board instead of by hospitals, the report argues.

In addition, all NHS patients should have the ‘opportunity to develop a health and wellbeing plan with a named health professional’ to help them ‘understand their risk profile’ and how to care for themselves, it says.

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