A new GPC position paper makes clear that the profession remains unwilling to accept ‘compulsory personal or practice responsibility’ for out-of-hours provision. Contract changes, it said, are not necessary despite suggestions from the secretary of state that provision could feature in the next round of negotiations.
The paper sets out the committee’s proposals for out-of-hours reform in the wake of pressure from government for GPs to ‘take back’ the services to help ease demand on emergency departments.
The GPC proposes community-based services led by local GPs with proper investment, citing examples of well-run services in Devon and Derbyshire, where integration of NHS 111 and out-of-hours GP services has been championed.
Key proposals in the GPC paper include:
- Robust CCG-led commissioning should integrate the health services involved in out-of-hours unscheduled care including telephone triage and advice, primary medical services out-of-hours, walk-in centres, ‘Darzi’ clinics, NHS 111, A&E tier 2 services and even some parts of the 999 service.
- Services provided by experienced, preferably local, health professionals, led by GPs.
- Out-of-hours, call handling and triage must not be separated from the treatment team.
- Providers need to be adequately funded. A population-base tariff may encourage commissioners to choose providers on the basis of quality rather than price. This
- money must not be taken from existing nGMS or PMS funding and must be ring-fenced.
- A nationally defined minimum £ per head investment may be appropriate.
- Commissioners must commission with quality rather than price being the foremost requirement.
- It may be worth allowing CCGs to become the providers as well as the commissioners.
- A level playing field for GP cooperatives, companies or federations to bid against large corporations to provide these services.
- Demand management is key, including increasing the willingness and ability of people to self-care where appropriate.
GPC chairman Dr Chaand Nagpaul, told GP the proposals presented an inclusive, integrated approach in the interests of all stakeholders.
The GPC was looking for feedback and for dialogue with NHS England and the government, he said, but the proposals would have wider policy implications.
‘The constraints caused by competitive tendering, for example, and the issues around integration, will require broader policy changes. And it will require developing the commissioning powers of CCGs,' he explained.
Dr Nagpaul called on NHS leaders and government ministers to support the proposals as they offered them a ‘way forward’ on out-of-hours care.