PBC groups may lead out of hours

The DoH believes out-of-hours responsibility could kick-start commissioning, writes Tom Ireland.

Although GP leaders say they haven't discussed 'even peripherally' the profession taking back 24-hour responsibility for patients, the DoH seems to be mulling it over.

The DoH, working closely with the NHS Alliance, thinks interest in practice-based commissioning (PBC) could be revived if the GP-led groups take control of out of hours.

The DoH's interest follows Conservative support for a similar idea earlier this year.

No coercion
At its Urgent Care conference in central London last week, the NHS Alliance was keen to play down reports that GPs would be forced to take back out-of- hours work. Opening speaker and NHS Alliance adviser Rick Stein assured delegates: 'That's not what we're saying.'

David Jenner, PBC lead at the NHS Alliance, said the idea is about PBC groups commissioning services. These groups may eventually merge with integrated care organisations to commission and provide.

The GPC thinks the idea is some way off. GPC chairman Dr Laurence Buckman said: 'It's never been discussed with us, ever. Not peripherally, not any kind of conversation.' He added that the NHS Alliance 'doesn't represent GPs or negotiate for them'.

NHS Alliance chair Dr Michael Dixon agreed the idea was in its early stages, admitting that PBC would have to develop before it could take on out of hours. But this could be what is desperately needed to kick-start interest in PBC, he said.

The DoH is also keen on the idea for this reason. In addition, it feels GP involvement could address inconsistencies in the current service.

'Practice-based commissioning is here to stay. The DoH wants to refresh and reinvigorate it,' DoH urgent care lead Chris Dowse said. 'With the NHS Alliance we are looking at how PBC can integrate with urgent care. We are very keen to support that piece of work.'

Dr Fay Wilson, GPC member and director of the Birmingham out-of-hours co-op BADGER, said PBC was an obvious way to improve services.

'It seems to me extraordinary the thought that PBC commissioners are fit to commission all sorts of services but they are not thought competent to run out of hours - it surprises me that people are surprised by these plans,' she said.

'The evidence suggests GPs will do a much better job of it than the people doing it at the moment.'

Divided opinion
Opinion is still divided among GPs over whether to take back the out-of-hours responsibility that they gave up with the new contract in 2004.

Some believe that taking the service back from private firms that operate it for two-thirds of the week would allow them to improve quality and fight negative press. Others say their quality of life has risen so much since opting out that nothing could persuade them to go back.

But Dr Wilson said many GPs seemed interested in out of hours. 'I don't see it becoming obligatory, but I am being asked by people how they can opt back in. It hasn't improved services and has fragmented care.'

The NHS Alliance's proposals would certainly not involve GPs working out of hours or being responsible for it unless they wanted to, as part of a PBC group, an integrated care organisation, a co-op or a private company.

Dr Wilson said the only thing that would stop the idea getting off the ground is the problem that has always plagued PBC - PCTs refusing to hand power to GPs.

'In the majority of areas in England PCTs don't want PBC to happen. GPs are interested, but they turn up to a PBC meeting and realise it's a talking shop. There was a lot of energy but GPs are disillusioned.'

Dr Dixon said having GPs in charge of out of hours would reassure patients.

'The fact that it is clinically led is what will wash well with patients. My patients like the idea of me co-ordinating their care. I think that is also why the government likes the idea, as patients will be receptive to it and it fits in with this idea of being clinically led.'


What do GPs think?

"I think it is a bad idea. The funding may still fall short and we will inevitably end up doing over and above what is actually needed. There may be some GPs willing to take this role on but the majority would opt out."
Dr Manjiri Bodhe, part-time partner, Bracknell

"The evidence suggests GPs will do a much better job of it than the people doing it at the moment."
Dr Fay Wilson, GPC member and director of BADGER out-of-hours co-op, Birmingham

"I think this is a better option as local doctors are in a better position to know the needs of their patients rather than a private company with shareholders to please."
Dr Liz Croton, locum GP, Birmingham.

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