Health Secretary Jeremy Hunt has reiterated the importance of GPs to the NHS and the need for a radical shift in the primary care model if healthcare services are to be sustained in the coming years.

In his hotly anticipated address to the RCGP conference in Harrogate yesterday, Hunt told delegates that "the NHS simply won't be sustainable without radical transformation of out of hospital care", and that the role of the GP is "fundamental" in this.

He spoke of three broad changes to improve care outside of hospitals, particularly for the frail and elderly in the first instance, that are to be implemented from next year:

- A move to proactive preventative care and freeing up GPs to do this. "GPs are micro-managed to death through QOF (Quality and Outcomes Framework) and myriad of targets", some of which do not have clinical value. This de-professionalises GPs, because every action is dictated by targets, he said;

- Integration of the health and social care system, to "prevent people from being pushed from pillar to post" and better pool resources. Chancellor George Osborn has already announced plans to allocate £3.8 billion of the NHS budget from 2015 to speed up integration, plans of which must be complete and approved by next year, he said; and

- Cracking the business of data sharing for more seamless care.

QOF reform?

Hunt was also keen to stress the need to look at reforming QOF, under which "every target has a good purpose but some are clinically less effective than others". And he touched on plans to look into whether practices can be given extra responsibilities, for district nursing and out of hours care, the latter of which is remains somewhat of a sore point with GPs.

One delegate's challenge to Hunt over moves to increase GP practice opening hours almost brought the house down. Noting that 8am-8pm seven days opening hours equates to an 80-hour working week, the delegate said "you can have continuity of care or access, but not both".

Hunt conceded that there is indeed a shortage of GPs, and admitted that the 2,000 more recently promised by the government is probably not enough to fill the gap.

Also speaking at the conference, outgoing RCGP chair Clare Gerada said the number of GPs needed is more like 10,000, and she stressed that without these, and a larger proportion of the NHS budget handed to general practice, "there is a serious risk of destabilising the whole NHS".