Doctors’ leaders have criticised the health secretary after he highlighted poor access to general practice and out of hours as a factor in high emergency care demand.

Jeremy Hunt also yesterday said “disastrous” changes to the GP contract - removing out of hours responsibility - had contributed to an additional four million people turning up in emergency departments each year.

Following the 2004 changes, 90 per cent of general practitioners stopped providing emergency cover, reports suggest.

Mr Hunt said that the changes have led to the “decline” in the quality of out-of-hours care.

But the British Medical Association said that Mr Hunt’s comments were “unhelpful” and accused him of “demoralising” NHS staff.

Speaking to Age UK’s annual conference in London, Mr Hunt said: “Let’s look at the biggest operational challenge facing the NHS right now - the pressure on A&E departments.

“The decline in the quality of out-of-hours care follows the last government’s disastrous changes to the GP contract, since when we now have four million more people using A&E a year compared to 2004.

“We must address these system failures - and look at the causes rather than just the symptoms as happened too often in the past.”

Mr Hunt also criticised the payment by results system, inferring that it led some patients to be pushed “from pillar to post”.

“I imagine every GP in the country has a story about sending people for a referral, only to have them sent back with an unhelpful note or a demand for a new diagnosis,” he said.

“The perverse thing is that payment by results actually encourages that.”

During the speech, the secretary of state said the NHS needs to “rethink” the role of non-hospital care, particularly its ability to prevent emergency admissions.

He added: “Too often people with long-term conditions are left to their own devices, without the help, care and guidance that local services should provide.

“Then something goes wrong and they end up straight back in hospital needing emergency care, at great cost to themselves as well as to the system.

“Our primary care system has become reactive when it needs to be proactive.”

Asked whether he thought GPs should take back responsibility for out-of-hours care, Mr Hunt added: “I have put the issue on the table because I do think we have an issue with the quality of out-of-hours care.

“I haven’t said how we’re going to address it because there is a lot of work we need to do over the coming months to work out the best way of addressing this.

“The point we have to get to is where the public have confidence in out-of-hours care.”

Mark Porter, chair of council at the BMA, said: “There is no doubt that the NHS is under intense pressure. Spending on healthcare is squeezed, patient demand is rising and staffing levels are often inadequate.

“The government’s analysis of where responsibility lies for the huge and increasing pressure on emergency care is completely simplistic.

“Singling out individual parts of the health service and engaging in a blame game is unhelpful and misses the point.

“Ministers should be engaging positively with healthcare professionals to improve and maintain services for patients, rather than demoralising NHS staff who are working harder than ever with fewer resources, wherever they are in the service.”

The union has written to Mr Hunt asking for an urgent meeting to discuss how “we can move forward and tackle the latest emerging crisis facing the NHS”, Dr Porter added.

Clare Gerada, chair of the Royal College of General Practitioners, added: “Once again, GPs are being used as a scapegoat and it is not acceptable.

“It is not true that the rise in demand on A&E services is due to a reduction in out-of-hours provision by GPs - and there is no evidence to prove that the increase is due to the GP contractual changes in 2004.

“We acknowledge that there has been a gradual rise in the numbers of patients attending A&E since 2004, but the numbers are calculated differently to a decade ago and now take into account attendance at walk-in centres and minor injury units.

“These are tough times for us all and one of the issues Mr Hunt should be addressing is the shortage of 10,000 plus GPs across all services, not just out-of-hours.

“As a National Health Service we should all be working together with government to improve patient care, not blaming GPs for perceived ‘inadequacies’ in patient care.”

Mr Hunt later tweeted that he would be “delighted” to meet the BMA to “discuss this further”.