GPs to visit elderly in care homes under new contract plans
Doctors will be required to make regular visits to nursing homes to check on elderly patients, under plans for a sweeping overhaul of the way GPs work.
Ministers want to impose a new legal duty on doctors to take responsibility for their patients’ care at evenings and weekends, and are to push their case in talks with the medical profession over the next six months.
The Health Secretary, Jeremy Hunt, is said to be deeply concerned about poor standards of care for patients outside hospitals and is determined to enforce a return to the culture of family doctoring.
He is understood to be ready for a direct confrontation with the doctors’ union, the British Medical Association, over reforms to GPs’ contracts if it is necessary to deliver more convenient and reliable services for patients.
Mr Hunt has already angered the BMA, which one Whitehall source described as “the worst trade union”, by demanding a pay freeze for the 1.3 million workers in the NHS.
The minister wants to defer next year’s plannned 1 per cent pay rise while reforms to NHS workers’ contracts are drawn up in preparation for the health service moving to a seven-day working pattern.
Since becoming Health Secretary 13 months ago, Mr Hunt has sought to define his role as the patients’ champion rather than the minister with operational responsibility for the NHS. Negotiations over the future of GPs’ contracts, due to conclude next spring, are expected to see Mr Hunt call for doctors to restore the ethos of traditional family care.
GPs, who are paid an average of £103,000 a year when they become partners, will be urged to visit patients in their own homes, including through regular rounds to check on frail pensioners in residential care.
Government sources said ministers wanted all England’s 8,100 GPs’ practices to be signed up to begin the new regime of regular care home visits by next May.
However, officials privately acknowledge that they are facing a battle to bring about a wide cultural change in surgeries across the country.
The BMA, the doctors’ trade union, is seen inside government as the greatest obstacle to efforts to raise standards of general practice.
Whitehall sources had hoped that the Royal College of General Practitioners would be more supportive than the BMA in backing the reforms.
However, earlier this week, the Royal College warned Mr Hunt directly that doctors could not accommodate more demands on their time. Budget cuts and overwork are threatening “catastrophe” for GPs’ services in England, the group said.
The planned reforms follow growing concern over inadequate and patchy locum services and agencies that are used to provide out of hours cover when GPs are closed at weekends and evenings.
The most infamous case involved Dr Daniel Ubani, a German locum doctor, who killed a British pensioner with an overdose on his first and only shift as an out-of-hours GP in the UK in 2008.
However, ministers are concerned that GPs’ services are routinely failing the public. Millions of patients have turned to hospital accident and emergency departments when their doctors’ surgeries were closed at evenings and weekends.
As a result, A&Es have come under intense pressure, causing patients to wait for hours in ambulances or on trolleys in corridors before they are seen.
The government has warned that emergency departments in some areas cannot cope with bank holiday weekends or cold winter periods due to the higher levels of demand.
Many patients have also found it more difficult to arrange routine appointments with their GPs in recent years due to their limited opening hours.
Mr Hunt blames the new doctors’ contract agreed by Labour in 2004 for many of the current problems.
Under the deal, GPs were no longer responsible for guaranteeing the standards of care their patients received out of normal office hours. However, pay rates rose sharply, with 670 doctors earning more than £200,000 last year.
At the Conservative conference last week, David Cameron outlined plans to extend opening hours for GPs.
Funding was announced for a pilot scheme in which a small number of practices will open from 8am to 8pm, seven days a week, and will hold consultations with patients via email, telephone and Skype video technology.
The first Ofsted-style inspections of GP surgeries will begin in January.
Dr Chaand Nagpaul, chair of the BMA’s GPs committee, denied that doctors were automatically opposed to the government’s reforms.
However, he warned that GPs were already “overworked” and suffering from “low morale and high levels of stress”.
There are more than 40,000 fully trained GPs working in England but Dr Nagpaul said the number of individual consultations they conduct has risen to 300 million a year.
“The rising patient demand, from care being moved out of hospitals and the ageing population, means that GPs are overstretched as it is,” he said.
“If GPs are to take on additional duties, we need more GPs. In the immediate future, we need to relieve GPs of other roles.”
He also warned that negotiations over the new GPs’ contract must not create a new “tick box” culture in which doctors are forced to visit patients in care homes needlessly.
