Radical plans shift 5% of services to primary care

Health White Paper - Access is key DoH priority as services move to primary care

Longer practice hours, more private providers and community-based treatment centres feature in the health White Paper as the government looks to shift 5 per cent of NHS services into primary care over the next 10 years.

The emphasis of the White Paper, 'Our Health, Our Care, Our Say', is to bring services closer to people's homes.

Six specialist clinical areas - dermatology, ENT, general surgery, orthopaedics, urology and gynaecology - are singled out to be provided in the community.

More primary care services

Quality framework data will be used to guide the change, driven through practice-based commissioning and community-based consultant-led clinics.

GP surgeries can expect an influx of therapists, counsellors and employment advisers under plans to bring health and social care closer together.

The DoH has asked all PCTs to review any plans for closure of community hospitals, which could house new services.

Private providers

In addition, the DoH will address health inequalities by allowing private and voluntary providers to tender to run GP surgeries. It will review the PCT funding allocation formula, with the worst-off areas seeing funding increases of about 20 per cent by 2007/8.

Access and registration

The DoH plans to boost access to GP services through longer practice hours and weekend surgeries, agreed and funded by every PCT. It is considering the introduction of an 'expanding practice allowance' to reward and help those practices that attract more patients.

To allow patients a wider choice of practice, stricter rules about open and closed lists will apply, with patients being able to switch GPs more easily. They would also be allowed to register with out-of-hours providers, and walk-in centres instead of surgeries, and register at practices further from home.

Plans for dual registration were scrapped, however, as they were deemed too expensive, complicated and at odds with 'the principles of continuity of care'.

Health MOTs

Health MOTs feature in the paper under the guise of 'life checks', but these will not greatly involve GPs.

Under the scheme, people can complete a voluntary questionnaire. Those identified at risk of ill-health will be referred to 'health trainers' for guidance on diet, exercise and other health factors. Only the most serious cases would be referred to GPs.

The DoH's director of primary care, Cheshire GP Dr David Colin-Thome, told GP that while 'some will complain about the changes', he hoped many GPs would see it as a way to enhance central services to help patients, adding that any extra work, such as longer hours, would be properly funded and supported by PCTs.

GP income falls

While the DoH believes that the White Paper offers opportunities for GPs to boost profits, accountants have reported the first downturn in GP profits since the start of the new contract. GMS practices with a September 2005 year-end report annual profits of £50.19 per patient, according to specialist medical accountants Ramsay Brown, a 2.3 per cent fall from June 2005.


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