Personalised GP care will bring back old-fashioned family doctors

Giving millions of elderly people a dedicated GP personally accountable for their care around the clock will bring back the era of the old-fashioned family doctor, Health Secretary Jeremy Hunt announced today.

Under changes to their contract with the NHS, GPs will ensure the four million patients aged 75 or over will get all the treatment they need for physical and mental conditions.

Other key changes introduce more transparency over practices’ earnings and performance, greater patient choice and fairer pay.

The new contract for 2014/15 was agreed between the British Medical Association’s General Practice Committee and NHS England, directed by the Department of Health.

Personalised care

GPs will oversee personalised care plans integrating all services, so the frail and elderly are better cared for in the community, reducing hospital admissions.

Out of five million emergency admissions last year, one third were people over 75, and more than one million could have been avoided.

GPs’ new responsibilities will include:

offering patients same-day telephone consultations;

offering paramedics, A&E doctors and care homes a dedicated telephone line so they can advise on treatment;

coordinating care for elderly patients discharged from A&E;

regularly reviewing emergency admissions from care homes to avoid unnecessary call-outs in future; and

monitoring and reporting on the quality of out-of-hours care.

It is hoped this service will eventually be offered to millions more vulnerable people with long-term conditions that need more support.

Secretary of State for Health, Jeremy Hunt said:

“The 2004 GP contract broke the personal link between GP and patient. It piled target after target on doctors, took away their responsibility for out-of-hours care and put huge pressure on our A&E departments. This government has a plan to sort this out and today’s announcement of a new GP contract is a vital step.

“We are bringing back named GPs for the vulnerable elderly. This means proper family doctors, able to focus on giving elderly people the care they need and prevent unnecessary trips to hospital. Rigorous new inspections of GP surgeries will mean every local person will know whether they are getting the care they deserve.

“This is about fixing the long-term pressures on our A&E services, empowering hard-working doctors and improving care for those with the greatest need.”

Chair of the Council of the Royal College of General Practitioners, Dr Clare Gerada said:

“This is welcome news for patients and for GPs as it will help us to get back to our real job of providing care where it is most needed, rather than more box-ticking.

“It is not the remit of the College to get involved in contractual negotiations, but we have been calling for this for three years and are pleased that the Government and the BMA have been able to reach a solution that is workable for doctors and, most importantly, focuses our time on improving the care that our patients want and deserve.”

Tick box targets

To free up more time for doctors to devote more time to patients, burdensome GP tick box targets will be scrapped.

There will be a reduction of more than a third of the Quality Outcomes Framework (QOF), which dictates how GPs should test and treat patients for specific conditions, such as diabetes and heart disease.

Getting rid of this rigid, one-size-fits-all approach will improve patient care as doctors will be trusted to use their professional judgement and make decisions based on what each individual patient specifically needs, taking all their conditions into account.

The money GPs currently earn from meeting these targets will instead be pumped into overall budgets and enhanced services.

Transparency

GP practices will publish results of a rigorous new inspection regime in surgery waiting rooms.

The Care Quality Commission’s chief inspector of general practice, Steve Field, will develop an easy-to-understand ratings system based on four categories: Outstanding, Good, Requires improvement, and Inadequate.

GPs will also look at how to publish details of their earnings.

Choice

Practices will also be freer to recruit patients from outside traditional boundaries, giving patients greater choice, informed with more information.

Patients will also be given a clearer voice to feed back their views and experiences with the introduction of the Friends and Family Test to general practice.

Other improvements to GP patient services will include making it compulsory for surgeries to offer appointments and repeat prescriptions online.

Pay

Automatic pay rises for older doctors will also be phased out as part of the government’s drive to get rid of progression pay across the public sector.

The £80 million cost of seniority payments, which are tied to length of service and average £6,000, will be re-invested in general funding for practices, based on the amount and types of patients they serve.

http://www.beverleyguardian.co.uk/news/local/personalised-gp-care-will-bring-back-old-fashioned-family-doctors-1-6246336

Keogh review puts GPs at heart of urgent care reform

GPs should work with other NHS services to deliver fast, consistent advice and urgent care outside hospitals around the clock, an NHS England review has said.

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Sir Bruce Keogh: urgent care reform plan

The bureaucratic burden on GP practices must be cut to boost access to primary care and reduce pressure on A&E, the review by NHS England medical director Sir Bruce Keogh argues.

RCGP chairwoman Professor Clare Gerada welcomed the report for highlighting GPs' vital role in urgent care without blaming the profession for existing problems.

Transforming urgent and emergency care services in England calls for a dramatic rise in the proportion of urgent care delivered closer to home.

But it warns that ‘many people are struggling to navigate and access a confusing and inconsistent array of urgent care services provided outside of hospital, so they default to A&E’.

Sir Bruce says A&E is a ‘trusted brand’, with an average wait of just 50 minutes for treatment and most patients treated within four hours.

But in a letter to health secretary Jeremy Hunt and NHS England chairman Sir Malcolm Grant, he warns: ‘The opportunities for bringing about a shift from hospital to home are enormous.

‘We know that 40% of patients attending A&E are discharged requiring no treatment at all; there were over 1m avoidable hospital admissions last year; and up to 50% of 999 calls requiring an ambulance to be dispatched could be managed at the scene.’

Sir Bruce argues that ‘starting from scratch, nobody would design the current array of alternatives and their configuration’, warning that the complicated NHS system itself is driving up demand by ‘sending people around various services, confused about who to call and where to go’.

The review calls for a series of changes to improve urgent and emergency care including:

• A ‘significantly enhanced’ NHS 111 with access to patient records, offering advice from a range of clinicians, appointment booking or call back by GPs and others, or a transfer to 999 services if necessary.
• Faster and consistent same day, every day access to primary care and community services for people with urgent care needs.
• Improved 999 services to handle more cases ‘at scene’, with support from GP advice.
• Two levels of hospital-based emergency centre, with standard centres and a tier of ‘major emergency centres’ with consistent levels of senior clinical staffing and more specialist capability.
• The ‘array’ of confusing terms for services should be reduced by co-locating community-based urgent care services in facilities uniformly referred to as ‘urgent care centres’.

Professor Gerada said: 'We are pleased that this report recognises the vital role of general practice and other community primary care services in providing care to patients with urgent needs. It is encouraging to see a report that sets out landmark changes in the way NHS emergency and urgent care will look in the future but that doesn't blame GPs.

'It explicitly recognises the sustained pressure and multiple demands on general practice in recent years, and the need to "create headroom" to transform the way we work so that we can continue to provide safe care for our patients. For the recommendations in this report to become a reality, that "headroom" has to include greater government funding and resources, including more GPs.'

GPC deputy chairman Dr Richard Vautrey said: ‘We would agree that the current system is too complicated and fragmented.'

Proposals to overhaul NHS 111 show the GPC is 'being listened to’, he added. ‘There is a need for more clinicians involved in dealing with calls so that patients are not only directed to the right service, but are given appropriate advice and if possible treatment through that one contact,’ he said. ‘The NHS 111 call service needs to be integrated with the see and treat elements of the urgent care service.’

Dr Vautrey said GPs already provide 24/7 services through daytime work and out-of-hours care. But he warned: ‘Both services are running hot in terms of coping with high demand and workload pressures.

‘We need a commitment from NHS England to reverse the fall in the proportion of funding spent on general practice so that both practices and out-of-hours organisations can start to take on additional staff to meet these growing demands. Expecting the current number of GPs to work harder and longer will simply lead to more GP burnout.’

http://www.gponline.com/News/article/1220721/Keogh-review-puts-GPs-heart-urgent-care-reform/