The current out-of-hours system is confusing and unpopular, says the Alliance's latest report on the NHS.
The document 'In Sickness And In Health' argues that the new contract has diluted GPs' core role of providing personalised, round-the-clock care. It suggests GPs should use practice-based commissioning (PBC) to share extended hours shifts and organise out-of-hours care.
The report set out examples of practices that treated urgent cases immediately in and out of hours using a telephone assessment to pass the patient to the appropriate clinician. GPs would be responsible for commissioning the urgent care pathways a patient may follow.
Incentives for working unsociable hours regardless of local need will not improve patient care, the paper says.
However, GPs taking responsibility for patients 24 hours a day will ensure continuity of care, it argues.
NHS Alliance chairman Professor Michael Dixon admitted that there might be an automatic reaction to reject out-of-hours responsibility by GPs.
GPs would not necessarily be providers of out-of-hours services, and the concept would not be imposed on GPs, he said.
'It is a way of restoring the GP as a unit for providing and commissioning continuity of care. It will save PBC budgets and ensure GPs have some control over who provides the service in their area,' he said.
Professor Dixon also said there should be more flexibility in the new extended hours enhanced service to allow local practices to share extended hours shifts.
'We felt the current extended hours arrangements are OK for large practices but smaller practices will not be able to absorb the costs. The answer must be to share rotas,' he added.
The report also calls for the tendering process to be simplified so that new APMS surgeries are not dominated by big businesses.
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