Out-of-hours care could be handed back to GPs under radical reforms to primary care outlined by Health Secretary Jeremy Hunt last week.

In a speech at The King's Fund, Hunt warned that the National Health Service will be "simply unsustainable" without a profound reform of care outside of hospital.

Improving care outside hospitals means a higher quality of life and fewer days in hospital, keeping people happy, healthy and safe at home and saving precious hospital resources for those who really need them, he said. 

Under his new vision for primary care, Hunt has already proposed a named accountable GP for all vulnerable older people, which, he says, is "the first set in reversing the historic mistake made in the 2004 contract changes".

Labour's 2004 changes to the GP contract, which essentially abolished personal responsibility by GPs for patients on their lists, were "well intentioned but undermined the ideal of family doctoring" and damaged the doctor-patient relationship, Hunt argues.

Elsewhere, to reduce the bureaucratic burden of targets such as the Quality and Outcomes Framework (QOF), there should be "a dramatic simplification of targets and incentives imposed on GP services", he said.

Also emphasised was the need to accelerate the integration of health and social care and improve use of electronic health records and plans, to help transform the quality of care received by vulnerable people in the NHS.

To help embed his plans for primary care, Hunt has called for the recruitment of an extra 2,000 GPs and to boost the proportion of new doctors entering general practice to 50%, and stressed that, if general practice is going to save the NHS money by reducing unplanned admissions to hospital, "then some of that saving needs to go back into general practice to pay for the higher levels of care".

Call for more funds

RCGP chair Clare Gerada has welcomed the intention to shift the focus from hospital to primary care, but says the plans don't go far enough.

She applauded Hunt's recognition of the "dire need" for more family doctors on the ground, the efforts to reduce bureaucracy, and that, if practices are to be given the right to opt back into out-of-hours provision, they must also retain the option to opt out.

"However, this speech will not end the crisis in general practice," she said, urging "a clear commitment for sufficient funding to enable general practice to deliver more services for their patients". 

The RCGP has long argued that while GPs carry out 90% of patient contacts within the NHS, they only get 9% of the budget, and warns "we are creaking under the strain of ever-increasing workloads, with dwindling resources."

Consequently, it has called on Hunt "to be bolder in recognising the need for a shift in NHS expenditure - so that general practice receives its fair share of NHS funding and GPs can deliver the care that our patients need and deserve."