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Clinical commissioners say GPs under pressure as A&E row escalates

NHS Clinical Commissioners, which represents a large number of clinical commissioning groups, has said GP “workloads are at breaking points and GPs are ready to buckle under the strain”, which will affect willingness to take part in commissioning.

NHSCC’s comments come after health secretary Jeremy Hunt reiterated his concerns about the role of out of hours primary care in the A&E problems.

Steve Kell, co-chair of NHS Clinical Commissioners’ leadership group and chair of Bassetlaw CCG, said in a statement: “We are hearing growing concerns from our members that at practices across the country workloads are at breaking points and GPs are ready to buckle under the strain.

“There is little doubt that a fire-storm has being whipped up over what is happening in Accident & Emergency Departments, with primary care provision, the GP contract and out of hours care being dragged into the mix.

“NHS Clinical Commissioners role is to speak for local commissioners, but as membership organisations we recognise that the morale of GPs is fundamental to how CCGs can operate. After all, if GPs are feeling squashed by their workload they are going to be far less able and willing to then engage on top of that with the commissioning agenda. CCGs need the foundations of strong general practice upon which to build.”

Dr Kell said: ““CCGs are best placed to lead on developing local solutions for local circumstances.  However we do believe the solutions for the current problems have to be ones for the system as a whole. We call on partners representing commissioners and provider including NHS England, the Foundation Trust Network and the NHS Trust Development Agency to work with us to identify solutions at scale which can then be adapted and implemented by clinical commissioning groups and area team in their role as direct and specialist commissioners.”

Mr Hunt, speaking on BBC One’s Andrew Marr Show on Monday, insisted he was not blaming GPs for the problem but said they must be made responsible for the out-of-hours service provided to patients on their list.

The health secretary claimed the service “deteriorated” when the GP contract was changed in 2004, with the public losing confidence and turning to A&E departments.

Mr Hunt said: “I would never blame GPs because I think they work extremely hard. I’ve been in GP surgeries and they have very, very long days.

“But I do think that contract is one of the contributing causes, yes, because I think what happened was when you removed the responsibility for services at the evenings and weekends from GPs, the service deteriorated and there’s a great loss of public confidence.

“If you need to speak to a GP out of hours, you’ll generally be speaking to someone who’s a long way away from you who doesn’t know you, can’t see your medical notes.”

While he was not calling for family doctors to personally be on call all night, he added: “I think we need to go back to GPs having responsibility for making sure that for the people on their list, there is a good service available.

“And I think the reforms we’ve had in the health service help to make that happen, but I think there’s lots more we need to do.”

Mr Hunt said having “better alternatives in primary care, a closer personal relationship between people and their GPs - something that many people think was lost by those contract changes - that’s going to be at the heart of the solution”.

Readers' comments (7)

  • Do any GPs read the HSJ? I was chatting to one at my local practice. Socially, I don't pop in for an appointment for a gossip. He's about the same age as me, mid 40s. He said OOH used to be dreadful, one in two, no life. His wife would take the calls (she wasn't clinical) and he'd leave the house with bits and bobs in an old fishing box, drive goodness knows where, see someone he didn't know, often registered with another practice and there was no e.g. ECP support. There weren't any halcyon days when OOH was rosy and you saw your family doctor, although I can remember that as a child. Yes, the system is a mess, and I've taken seriously ill relatives to ED with a list of what medicines they're on and what they need, but the work life balance for GPs pre the latest contract sounded dreadful. And the issue re not seeing notes/ health records doesn't seem to've changed in 40 years.....

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  • Let's not forget that many GPs are spending time running CCGs rather than doing the job they're trained to do: Treating patients. No wonder patients are showing up in A&E! I can only hope this expensive disaster of a reform is repealed by the next Government.

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  • Some GPs do read the HSJ, mainly when we are involved in commissioning. We tend to read Pulse more often.
    I like the contrast between the two.
    Pulse says Jeremy Hunt and the DH hate GPs, HSJ shows why Hunt and the DH hate GPs.
    Neither find a way to get him to love us

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  • How does this tie with innovation. Knee jerk reaction of the way it was instead of thinking how we need to go forward. I agree a robust system is better than I am doing a shift. Everyone is more complex. Are we sure the skill set is defined in this new world. I have concerns if an OOH doctor is covering a community hospital. Why is always better to go to the patient instead of the patient to come I a unit? It doesn't have to be an A&E. People think different. GP's and their staff are under pressure.This has to be acknowledge. It is just that you don't see the waiting times because of the duty of care. How would the NHS react if the pratices start posting awaiting times or red alert days. It is unacceptable..If we are to improve the system the money must be shifted but if you are a foundation trust..that is money in the pocket. Also how many foundation trust have money in the bank but don't reinvest in the staff? Two sides to every story

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  • Maybe the consumer just wants to by-pass the GP? Too many stories of missed diagnoses. Maybe they just want to go straight to A&E to avoid weeks of worry. Perhaps patients no longer want to go through the "trial and error" method of diagnosis in general practice - where only persistence and Google can get to the answer. The corner shops disappeared a long time ago for serious shopping, maybe it is time for a radical change in first line contact. Do the market research, and then provide services where patients want to be seen and by whom.

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  • The much hailed 'once in a generation' darzi review promoted Darzi clinics, where patients could see GPSIs/ consultants and get diagnostics without going to a hospital.

    Darzi got a oat on the back, the review was buried and we moved swiftly on to the Nicholson challenge.

    Perhaps time to dust down the Darzi report and recognise that we are treating 21st century morbidity and consumerism with 19th century models of care.

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  • Insiderperspective

    What you are describing is a hospital of sorts - just one with no beds and either poorer quality diagnostics or duplicated diagnostics. And of course with some patients then facing being shunted between polyclinic and proper hospital.

    The previous poster is correct. We now live in a faster world with greater convenience to the consumer and lower waits - next day delivery almost feels like too long to wait. We will increasingly expect the same instant availability and fast diagnosis from our health care systems.

    How many of us now -particularly those of us who rarely go to a GP - research our symptoms beforehand and present tp a GP with a pretty good idea of what we need next, only to find that we know more about the possible diagnoses than the Doctor and have to wait patiently until he or she hits on the right course of action.

    Why not turn around the current policy, which is failing miserably, and accept that primary care should focus on patients with existing diagnoses. Their aim should be to keep patients with chronic conditions and the elderly under review and as healthy as possible. The rest of us should be able to book to see an appropriate specialist via an NHS Direct style, symptoms based, booking web site and when we are ill but don't know who to see, should be encouraged to use expanded A & E services with polyclinic style annexes developed ASAP.

    It will always be too expensive to provide the instant access patients will increasingly demand in GP surgeries. It shouldn't be unaffordable to cut out the middle man and provide excellent, easy access diagnostic centres adjacent to A&E.

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