GPs could oversee out-of-hours care from 2014, says GPC

GPs could agree to take responsibility for oversight of out-of-hours service quality as part of the 2014/15 contract, a GPC negotiator has said.

Dr Peter Holden: out of hours compromise deal
Dr Peter Holden: out of hours compromise deal

GPC out-of-hours care lead Dr Peter Holden suggested he was prepared to compromise with ministers in ongoing contract negotiations.

While firmly rejecting a return to a pre-2004 situation with individual responsibility, and ruling out GPs taking responsibility for the quality of services they do not provide, Dr Holden said GPs could, however, provide ‘oversight of quality’. ‘Yes, I think we can do that, with some caveats,' he said.

He was also ‘willing to discuss’ GPs taking county or conurbation level responsibility for services.

Health secretary Jeremy Hunt has said GPs should take back control of out of hours services, and blamed the 2004 contract opt-out for rising pressure on emergency departments.

Speaking at the annual conference of Urgent Health UK (UHUK), the umbrella group for social enterprise providers, Dr Holden said ministers would not let GPs ‘get away with nothing’.

‘The government’s not going to let us get away with nothing. That is the bottom line. Given we haven’t the workforce … what can we do to help the system?’

Dr Holden called for a ‘whole system’ approach to urgent care management with out-of-hours and NHS 111 integration.

‘If we are going to oversee whole system care, it means us saying to the director of social services: "That lady did not need to go to hospital last night. The reason she went is because you lot couldn’t produce a social services bed."

‘That’s the level I think we should be at. But the concept that hordes of us should be out on the roads nights and weekends is not going to wash.’

‘We do not have the number of GPs capable of handling the ten-fold increase in demand on out-of-hours care. And the ten-fold increase is not need, it’s want.’

Dr Holden said contract negotiations were ongoing, but GPC would publish new proposals on out-of-hours services, NHS 111 and whole system care within the next three weeks.

UHUK chair Dr Mark Reynolds outlined his organisation’s proposals for GP membership of social enterprise providers to oversee service quality.

‘GP member practices could opt in to be members of our social enterprises without any obligation to produce workers for the out-of-hours rota. The obligation would be to receive quality statistics, receive performance reports, and feedback issues of concern and issues of praise to and fro.

‘The social enterprise can say our board and our governance structure is intimately related to the GP practices in the area, that is a measure of oversight and responsibility from the local GP community.’

Dr Reynolds said the plan had been submitted to GPC and had received positive feedback from senior general practice leaders.

‘The question is, is that sufficient compromise, sufficient a step to satisfy the political needs of Jeremy Hunt,' he added.

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