GP leading future of primary care consultation denies Hunt conflict

The GP leading NHS England's call to action consultation on the future of primary care has welcomed the health secretary's latest intervention on general practice reform, and denied Jeremy Hunt's pronouncements conflict with his own work, despite warning against 'top-down' approaches to change.

Dr Bewick: 'I do think we need to listen to patients about where the gaps are in their care.'
Dr Bewick: 'I do think we need to listen to patients about where the gaps are in their care.'

Speaking to GP at the King’s Fund conference on the future of primary care in London today, Dr Mike Bewick, said the health secretary's plans, announced this week to make GPs responsible for elderly patients’ care around the clock across primary, community and social care from next year, would ‘complement’ rather than ‘affront’ his work at the NHS quango.

Dr Bewick, who launched his consultation last month, said Mr Hunt’s plans fit with his own principle of continuity of care in primary care transformation.

The health secretary, who will give the keynote address to the King’s Fund event this afternoon, has come in for criticism from GP leaders for his plan.

GPC negotiator Dr Dean Marshall told GP the health secretary's proposals were unworkable, and 'based on a 1950s view of general practice'. 

But Dr Bewick said Mr Hunt’s focus on elderly and vulnerable people was timely following Francis, and welcomed the minister’s focus on holistic or comprehensive care.

‘Predictably you will get two views,’ said Dr Bewick on Mr Hunt’s plans. ‘The first is: ‘Well that’s what we are doing anyway’, the other one is: ‘Isn’t this more work?’. I think it’s only more work if you don’t look at the pathway and say: ‘What is the hospital responsible for, what is it we are responsible for, and how do we join that up?'’

He said the named clinician proposal was one way to ensure patients did not fall through the cracks of the NHS, but he would expect practices to develop their own approaches as well.

Earlier, Dr Bewick repeated his wish to bring CCGs closer to general practice commissioning.

‘CCGs are not in a position to commission primary care. And I think we might need to change that. Not that they’ll have the primary role to do so, but certainly the primary responsibility to work with area teams to do so. And to do that more than looking at quality, but around system redesign. I don’t know how we are going to do it unless those two come together. I’m not reforming PCTs, I’m talking about how you harmonise the system.’

He warned that the NHS would go ‘out of business’ if it did not change.

‘We cannot continue to grow a deficit in healthcare as we are doing at the moment.’

He added: ‘One of the secrets is to set up a framework and allow the people out there design it, not the centre.’

In a previous session, Dr Bewick said: ‘I don’t believe you can redesign primary care, or integrated care, by a top down approach. That’s never worked in the past, and it will never work in the future.’

Talking about the changing GP workforce, Dr Bewick said patients often complain they never see the same doctor twice.

‘Whether that’s ever going to be possible again in terms of the whole population, I do think we need to listen to patients about where the gaps are in their care. And it might not mean you see the same doctor all the time, but you might see the same health professional who then calls upon the doctors’ time when there are crisis or complex issues.’

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