A new report has suggested that GPs should resume responsibility for out-of-hours care of patients, and that a new ‘consultant’-type role should be created for advanced GPs to ensure better co-ordination of patient care.

In Sickness And In Health, a new report from the NHS Alliance, proposes that GPs should take back the responsibility for co-ordinating the provision of out-of-hours services. Currently the responsibility for ensuring provision of out-of-hours services lies with the local NHS primary care trusts (PCTs), who commission the services from a variety of private and not-for-profit providers.

Launching the report, NHS Alliance chief executive Michael Sobanja was keen to stress that this should not mean GPs should go back to being on call 24-hours a day, as had been the case prior to the new GP contract (introduced in 2003). Under that contract, GPs gave up about £6,000 a year in return for relinquishing out-of-hours responsibilities. This is almost universally now regarded to have been a triumph of negotiation by the British Medical Association on GPs’ behalf, but having given the PCTs too little money to commission good quality out-of-hours services.

Discontinuity of out-of-hours care is thought to be a factor in the significant increases in hospital A&E attendances over recent years. As well as the varying kinds of PCT-commissioned out-of-hours services, the phone and online NHS Direct service has been another option for patients needing care outside GP surgery hours. NHS Walk-in Centres, Minor Injury Units, Urgent Care Centres and out-of-hours Centres have also formed part of a matrix of providers.

Dr Michael Dixon GP chair of the NHS Alliance, said: “When the GP contract was negotiated, we didn’t have practice-based commissioning or any other mechanism that would allow GP practices to commission out of hours and urgent care. Now we have the means, we should grasp the opportunity. Many doctors are concerned that healthcare is becoming more fragmented – highlighted by a recent survey that found one in five GPs would be willing to return to working out of hours. The decisions about who should provide what services need to made locally, as close to the patient as possible, by GP have practice-based commissioners supported by their PCT. We have to build care around the patient, instead of expecting the patient to navigate a system that is convenient to the service.”

New 'super-GP' role
The report’s other major points suggest the creation of a new ‘super-GP’ – the Community Specialist Consultant. This new post would be equivalent to a hospital consultant, but with special training in the clinical and management skills needed to work across the boundaries between hospitals and primary care.

Dr Minoo Irani, a consultant paediatrician who practices in the community and who contributed to the report added that “traditionally we have expected the patient to come to us. But we can transform patient care if we go to him”. Having himself made the move out of hosital to become a community-based consultant, Dr Irani has found that “a whole new set of skills is needed to work effectively outside the hospital. “We need to understand more about primary care and social care services, and about prevention issues. “Working in the community should be seen as a genuine career option for specialists and consultants.” By Andy Cowper