The BMA has slammed the government for blaming the rocketing demand on accident and emergency departments in England on general practice and out of hours services.

Health Secretary Jeremy Hunt called up a storm last week when he said changes to the GP contract in 2004 - which allowed GPs to opt out of providing out of hours care for a small pay cut - had sparked a rise in the number of patients attending A&E, to the tune of four million extra a year.

The BMA argues that the reasons for the increased pressures are "complex and not fully understood".

In a letter to Hunt, the Association claims that, while out of hours care plays a role, "soaring demand on services, unmatched by increasing resources, along with insufficient staffing" are just some of the reasons affecting the whole of the National Health Service, not just A&E.

In a separate release, Mark Porter, Chair of BMA Council, said "the government's analysis of where responsibility lies for the huge and increasing pressure on emergency care is completely simplistic," and added that "singling out individual parts of the health service and engaging in a blame game is unhelpful and misses the point".

“The BMA has made it clear for many years that the provision of out-of-hours care in England needs to be improved, particularly in how it is resourced and co-ordinated, but it is wrong to blame the GP contract for problems with the system," noted Laurence Buckman, Chair of the BMA’s GP committee, and he described the government’s analysis of the problem as "extremely inaccurate".

Taking the argument to Twitter, GP Steve Field, Deputy National Medical Director at NHS England, said the causes of the A&E crisis are complex, "solutions will be too, but must involve general practice".

Also commenting on the issue, Steve Kell and Amanda Doyle, Co-Chairs of NHS Clinical Commissioners Leadership Group, said: “It is quite clear that out of hours care needs to be improved. Professor Steve Field is absolutely right when he says that finding a solution must involve GPs and we would take that one step further and say that what it needs is the direct involvement of local commissioners to find that solution"

Call in the commissioners?

“As the current concerns about A&E and the recent issues with NHS 111 clearly show, CCGs are best placed to work within their areas to develop appropriate solutions by specifying and commissioning high quality services," they stress.

Also on Twitter, Clare Gerada, chair of the Royal College of General Practitioners, said there is no correlation between the change in GP contract and rise in A&E admissions.

There is "no evidence that GPs are ‘too blame’ for crisis in A&E. It’s hard enough being a GP at moment without this," she said, and blamed the rise in patient number on different ways of coding information, and a lack of access to social care.