Category Archives: Jeremy Hunt
GPs reject call to take over out-of-hours care
Doctors at BMA conference vote almost unanimously against proposal to place them back on call at evenings and weekends
GPs yesterday overwhelmingly reiterated their opposition to taking back responsibility for providing out-of-hours care, with some predicting that many older family doctors would quit if that was imposed on them.
About 400 delegates representing Britain’s 40,000 GPs almost unanimously rejected a call at a British Medical Association conference for family doctors in England to once again become responsible for looking after ill patients overnight and at weekends, as they were until 2004.
The vote, at the annual conference of the BMA’s local medical committees (GP branches), came after the health secretary, Jeremy Hunt, was reported to want GPs to go back to the earlier arrangement.
Dr Richard Vautrey, deputy chairman of the doctors’ union’s GP committee, said: “There was a very strong view that this would be the last straw for large numbers of GPs, if they were forced to become the provider of last resort and be on call overnight and at weekends, on top of their normal workload.
“The conference was at one in opposing any change that GPs would be taking back out-of-hours care. The BMA’s view remains that GPs who have made the choice not to have personal responsibility for it should not have to do it.”
An impassioned debate heard GPs argue that most family doctors over 50 would quit the profession if they had to resume provision of out-of-hours care. One remarked, “Over my dead body.”
Advance reports earlier this week of a major speech Hunt was due to give to the King’s Fund health thinktank on Thursday gave many GPs the impression that he wanted to again make them responsible as a way of tackling the often inadequate state of out-of-hours care, which since 2004 has been provided by a mixture of private companies, GP co-operatives, urgent care centres and walk-in centres.
Sources close to Hunt say prior media coverage has wrongly portrayed his views. On Thursday morning he said: “Ultimately, we want GPs to be responsible for out-of-hours care.” But when he delivered his speech that afternoon, he called the 2004 change an “historic mistake” but, in an attempt to assuage mounting anger among GPs, made clear that “No one is suggesting that GPs should go back to being personally on call during the evenings or weekends. They work hard, they have families and they need a life too.”
Hunt says he simply wants local GPs to be responsible for ensuring that the provider of out-of-hours care in their area will offer a high-quality service – a job already done by the new GP-led clinical commisisoning groups.
More positively for Hunt, LMC representatives rejected by 60 to 40 a motion expressing no confidence in him after GPs, including the influential chair of the BMA’s GP committee, Dr Laurence Buckman, warned them that such a move would be “attacking the person, not the policies” and would damage the union.
The motion criticised Hunt for “misrepresentation of GPs to the public and press”. In another vote, delegates rejected plans for GP surgeries to open seven days a week as part of plans being pursued by Sir Bruce Keogh, the NHS’s medical director, for the NHS to provide key services in hospitals and at least some GP surgeries every day of the week, in a bid to improve care and reduce avoidable deaths.
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Jeremy Hunt proposes a rewriting of GPs’ contracts – video
Jeremy Hunt discusses proposals to rewrite GPs’ contracts on Thursday in a speech at the King’s Fund in London
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GPs threaten to quit commissioning to concentrate on patients
Doctors’ leader says GPs finding it increasingly difficult to reconcile sharply rising workload with new managerial duties
GPs may have to give up working with the new NHS organisations that control £65bn of treatment budgets, to help their surgeries cope with the sharply rising workloads, medical leaders are warning.
A few GPs have already pulled out of involvement with their local clinical commissioning groups (CCGs) because they could not spend enough time with patients while also helping run the groups. The growing demand for GP services is also making others consider withdrawing, even though CCGs are meant to be GP-led.
Dr Clare Gerada, chair of the Royal College of GPs, said the difficulty of reconciling patient care with new managerial duties in their local CCGs meant it was “inevitable” some GPs would pull out of the CCGs.
The 211 CCGs are the key new NHS organisations that, as a result of the coalition’s NHS shakeup last month, replaced primary care trusts as the bodies to commission and pay for treatment for patients across England.
“Sadly, for some GPs being involved with CCGs is taking up considerable amounts of their time. If you have a workforce crisis and if you have a workload that’s not getting easier, it’s inevitable that we must be in the consulting room trying to address that rather than in CCG board meetings outside consulting rooms, doing what could be done by managers. This is already happening to some extent”, said Gerada.
“I find what many CCGs are doing immensely useful. But when push comes to shove, if GPs have to choose between seeing patients and involvement with a CCG, our first duty as clinicians is to our patients.”
Dr Kailash Chand, the British Medical Association’s deputy chair and a former GP who was awarded an OBE for his services to the NHS, said some GPs could not perform both roles adequately.
“About a quarter of GPs in England are involved in some way with their CCG, whether as the chair or just as someone who sits on one of their committees, and thus has a lot of meetings to go to. That extra work related to commissioning services is cutting into the time they can spend with patients, just at the time that demand for GP services has been going up, so some GPs now have too much to do,” said Chand.
“Some have already pulled out of active CCG work – attending meetings – because they can’t cope with the dual workload of the managerial stuff around commissioning and looking after patients. While that’s not happening on a large scale at the moment, it could become a wholesale pulling out if [the health secretary] Jeremy Hunt tries to force GPs to resume responsibility for providing out of hours care.”
Meanwhile, a row between the government and the medical profession intensified as the leader of Britain’s GPs accused the health secretary of “spouting rubbish” and rejected his demand that family doctors take back responsibility for out-of-hours care.
Dr Laurence Buckman, chair of the British Medical Association’s GPs committee – which represents the UK’s 40,000 GPs – launched a sustained assault on Hunt over his “denigration” of GPs and his blaming of them for the growing crisis in A&E care.
Buckman’s speech, to Thursday’s annual conference of the BMA’s local medical committees (GP branches), highlighted the increasingly vocal unease about Hunt’s approach felt by the BMA and the medical royal colleges which represent the UK’s nurses and GPs.
Buckman rejected Hunt’s call for GPs to resume responsibility for providing out-of-hours care overnight and at weekends in England, as they did until 2004 when 90% chose to cease doing so in a revised contract deal with the then Labour government.
NHS Clinical Commissioners, the organisation that represents about 130 of the 211 CCGs, warned that “at practices across the country, workloads are at breaking points and GPs are ready to buckle under the strain” – and that Hunt’s blaming of GPs for the alarming rise in patients attending hospital A&E departments was damaging GPs’ morale.
Last month, Dr Chandra Kanneganti resigned as the clinical director for unscheduled care with Stoke-on-Trent CCG, just days after it assumed its powers on 1 April. He told the Pulse medical website at the time: “We need to spend more time at practices than we did before. Practice and patients are our main priority. With the recent changes in the [GPs'] contract, I’m not sure how long I can spend time on my commissioning duties. I don’t want my patient care compromised.”
Hunt on Thursday struck a more emollient tone towards GPs in a speech setting out ways to improve the quality of primary care, such as hiring a new chief inspector of primary care and rating GP surgeries.
On Tuesday, Hunt had claimed that GPs’ failings were leading to overcrowded A&E units. Dr Laurence Buckman, chair of the BMA’s GPs committee, yesterday made clear that GPs could not and would not take back responsibility for overnight and weekend care, a key ambition which Hunt reiterated.
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Jeremy Hunt under fire over GP reforms: Politics live blog
Andrew Sparrow’s rolling coverage of all the day’s political developments as they happen, including Jeremy Hunt’s speech on GP reformsAndrew Sparrow
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GP chief to launch scathing attack on Hunt
Speech by Dr Laurence Buckman to BMA conference to say plans unrealistic and health secretary doesn’t bother with facts
The growing row between the government and the medical profession will get worse when the leader of Britain’s GPs accuses the health secretary, Jeremy Hunt, of “spouting rubbish” and rejects his demand that family doctors take back responsibility for out-of-hours care.
Dr Laurence Buckman, the chair of the British Medical Association’s GPs committee – which represents the UK’s 40,000 GPs – is to launch a sustained personal assault on Hunt over his “denigration” of GPs and his blaming of them for the growing crisis in A&E care.
Buckman’s speech, to Thursday’s annual conference of the BMA’s local medical committees (GP branches), will highlight the increasingly vocal unease about Hunt’s approach felt by the BMA and the medical royal colleges which represent the UK’s nurses and GPs.
Buckman is set to reject Hunt’s call for GPs to resume responsibility for providing out-of-hours care overnight and at weekends in England, as they did until 2004 until 90% chose to no longer do so in a revised contract deal with the then Labour government.
Hunt this week claimed inadequacies in out-of-hours care lay behind the ongoing rise in people seeking help at hospital A&E units, which NHS leaders and emergency doctors warn is unsustainable and has put patients’ safety at risk.
Buckman is due to tell the 400 delegates at the conference: “Despite all the evidence, Hunt continues to tweet that it is all the fault of the GP contract. This is because he does not want to bother with the facts when he can have a bash at those of us who, on his own admission, are overworked and strained beyond endurance.
“The fact is GPs are undertaking more consultations per patient and we are diagnosing and treating more conditions than ever before. The fact is that GPs cannot become the providers of last resort for urgent out-of-hours services.”
In a strongly worded attack on a range of Hunt’s policies on the NHS and doctors, Buckman will also argue that many GPs already work 14-hour days and do not have the capacity to start advising and treating patients out of hours.
“While we must play our part in ensuring better continuity of care for our patients, we cannot – and will not – go back to GPs working dangerously long hours or having unrealistic expectations heaped upon us. We need to be freed from the oppression of box ticking and micromanagement. “
He is also to point out that Mike Farrar, the chief executive of the NHS Confederation, which represents hospitals, this week rejected Hunt’s claim that Labour’s deal with doctors had led to the collapse in public trust in alternatives to hospital-based emergency care.
Buckman is to accuse the health secretary of ignoring the evidence, saying: “Hunt has continued to spout this rubbish when on Tuesday, he told MPs that our contract had had a devastating impact and that pressures on A&E services were direct consequences of the disastrous changes.”
And in remarks that may be interpreted as a threat that GPs could stop working with existing out-of-hours providers, he will also say: “GPs are not prepared to shore up a system that has been rendered unsafe by unwise political meddling. We are happy to work closely with others, including CCGs where there is full GP input, to improve out-of-hours services.”
Buckman’s intervention comes a few hours before Hunt is due to repeat his blaming of GPs for problems in A&E services to senior NHS managers at a conference organised by the King’s Fund health thinktank and outline plans for a new system of tough ratings of GP surgeries and the creation of a new post of chief inspector of primary care to monitor standards.
Hunt, responding to the criticism, said: “There are many reasons for increasing pressures on A&E services, including access to and confidence in out-of-hours care, increasing numbers of people with long-term conditions and the fact that A&E is sometimes the quickest way for patients to access the NHS, no matter what’s wrong with them.
“I do not blame NHS staff for this. They are working extremely hard in the face of rising demand, in fact it’s they who are telling me how much better things could be organised. So we want to help free up GP practices from the box-ticking culture they and other NHS staff have to work in, to allow them to focus on providing the best quality care. GP practices have been turned into places where it’s a daily challenge for receptionists to cope with huge call volumes and GPs to get through to all the people they need to see.
“Ultimately we want GPs to be responsible for out-of-hours care. This doesn’t mean they will be delivering the service, but they will be responsible for making sure it is provided so patients have access to the right care to suit their needs.
“We are fully aware of all the good work that GPs do in their communities. In fact, we want GPs to work with us on these fundamental changes to the system that most people working in the profession want to see delivered.”
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Government accused of using ‘anti-GP rhetoric’ to mask its own failings
Jeremy Hunt accused of demoralising GPs and causing fear among patients before speech attacking ‘inaccessible’ doctors
Doctors’ leaders and the health secretary are on a collision course over claims the government is using “anti-GP rhetoric” to mask its own failure to effectively reform the NHS.
In a speech on Thursday at the King’s Fund Jeremy Hunt, the health secretary, will attack “inaccessible” GPs for leaving the frail and the elderly with no alternative but to fill up hospital accident and emergency waiting rooms. Hunt will call for a new chief inspector of GPs to crack down on poor performers.
Hunt points to “GP surgeries where it is often impossible to get an appointment the next day; same-day appointments but only if you call at 8 o’clock in the morning sharp and are lucky getting through; long waits on the phone to get through, sometimes at premium rates”.
The health secretary will also call for a new Ofsted-style rating system for hospitals, pointing out that the King’s Fund found almost three-quarters – 73% – of NHS professionals do not think that quality of care in the health service is given enough priority. In its first look at the NHS since the Francis report into scandalous levels of poor care at the Stafford hospital, said trust boards “must demonstrate that they give sufficient priority to quality and patient safety”.
However, doctors have hit back – and are producing posters to be placed in surgeries defending the profession, emblazoned with the words: “GPs want to spend more time with you, not red tape” – a dig at the health reforms which have increased their managerial responsibilities.
Michelle Drage, the leader of London’s GPs, wrote on her website: “No doubt you are as sick as us of the anti-GP rhetoric in some of the media. We think it’s time we put the record straight about general practice.”
Drage said the health secretary’s comments were demoralising GPs and causing fear among patients. “GPs are on the edge and we are seeing this when no one appears to be getting a grip on the NHS. Who is running the NHS? Is it the GPs? Is it NHS England? Is it the secretary of state?”
Hunt’s speech will come as GPs gather for their annual conference, which Drage says will be “electric”. She said: “Either [Hunt] does not get [the NHS] or he gets it and does this deliberately. Either way it’s a pretty bad situation out there.”
Hunt has already faced criticism for linking the crisis in hospital A&E departments with GPs opting out of out-of-hours care. Mike Farrar, the chief executive of the NHS Confederation, the body representing organisations commissioning and providing health services, questioned Hunt’s assertion that Labour was to blame for a public loss of confidence in alternatives to casualty by agreeing a new contracts with family doctors in 2004. Farrar was the person who negotiated the contract with GPs.
A spokesperson for the Department of Health said the health secretary was not “doing GP bashing. We are not proposing to tear up the GP contract. We want to work with the GP community to reduce bureaucracy and get rid of the targets that make it difficult for them to get on and treat patients quickly.”
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NHS chief to quit next year
Official criticised for role in Mid Staffs scandal to step down in March next year
Sir David Nicholson, the chief executive of NHS England, dramatically announced the end of his six-year reign after sustained criticism of his role in the Mid Staffs hospital scandal made it impossible for him to continue as the public face of the health service.
The £211,000-a-year official had been subjected to weeks of attack from some newspapers – the Daily Mail being the most virulent, dubbing him “the man with no shame” – following publication of the Francis report, which was highly critical of care at the Stafford hospital for four years from 2005.
Nicholson was briefly head of the local strategic health authority when the first serious concerns about Mid Staffs emerged, although he was not directly criticised. Campaigners and hostile newspapers cited that brief tenure, though, to say he should have resigned “long ago”.
Despite the pressure, some of which came from Conservative cabinet ministers, Nicholson retained the support of Downing Street. His decision to step down from March next year also “surprised” the health secretary, Jeremy Hunt, who had been a supporter.
Nicholson emerged from the shadows in October last year, announcing a series of initiatives to require hospitals and GP surgeries to carry out operations and see patients seven days a week plus a nationwide review of emergency healthcare services.
Since the publication of the Francis report in February he has been largely silent, leaving the stage to his deputies and allowing Hunt, who is no longer directly accountable for running the NHS, to grab the headlines.
It was left to the professional body representing senior NHS managers to rebut criticism from Hunt that the poor performance in accident and emergency wards was down to Labour’s changes to GP contracts.
He was meant to give his first press conference at a key NHS conference in two weeks’ time, and his media team had concerns about his reception from certain quarters of the press.
Nicholson’s announcement comes at a critical point for the NHS. The coalition’s health reforms have just come into force – with GPs for the first time buying care directly for their patients and a flock of private providers emerging to rival the NHS – just as the service is struggling to make £20bn in “efficiency savings”.
Initiatives meant to reduce costs – such as the new NHS non-emergency advice line – have already caused harm to patients.
Those who worked with Nicholson in the Department of Health said he “could never have articulated his vision for the NHS because every time he pops up there’s a media furore”.
However, there was anger from campaigners that Nicholson, who has worked in the health service for 35 years, will walk away with a pension of at least £1,875,000 when he retires, according to NHS figures published in March last year.
Julie Bailey, from the campaign group Cure the NHS, said: “It is an obscene amount of money for failure. He will be able to enjoy the rest of his life, unlike us – we are left with memories of our loved ones suffering under his watch.”
Nicholson was appointed NHS chief executive in 2007. In the coalition’s new NHS, he controlled more than £95bn of health spending. Sources say his announcement gives the chair of the NHS, Professor Malcolm Grant, time to plan an orderly succession.
As a quango, NHS England is outside direct ministerial control and the health secretary has no say in the new appointment.
Sean Worth, former special adviser to David Cameron, worked with Nicholson on the coalition’s controversial health bill.
He said: “The big problem is who replaces him. Like him or not, he’s hugely competent and the names being speculated on to replace him are minnows in comparison.”
Inside the department, the odds-on favourite to take over is Ian Dalton, current president of global health at BT. He was Nicholson’s deputy until he left for the private sector this year.
In a letter to Grant, Nicholson said: “I have only ever had one ambition and that is to improve the quality of care for patients. I still passionately believe in what NHS England intends to do.
“My hope is that by being clear about my intentions now this will give you and the board the opportunity to attract candidates of the very highest calibre so they can appoint someone who will be able to see this essential work through to its completion.”
But it was events at a small hospital in the heart of England that came back to haunt him at the height of his powers.
The 57-year-old had issued a full apology after the Francis report was released, to “patients, relatives and carers [who] found themselves in the position where they not only had terrible things happen to them but the very organisation they looked to for support let them down in the most devastating of ways”. But this did little to assuage the anger felt.
Sir David’s supporters say his decision to step down is personal – he has just become a father again. “I think we will see a liberated man … which will be interesting,” said one source.
Hunt said: “Under Sir David Nicholson’s leadership, NHS waiting times have fallen, infection rates reduced, and mixed-sex accommodation is at an all-time low.
“His job has often been incredibly complex and very difficult, and yet he has always had a reputation for staying calm and maintaining a relentless focus on what makes a difference on the NHS frontline.
“I am also grateful to him for overseeing the successful setting up of NHS England and giving us an orderly period in which to select his successor.”
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Hunt wards off hospital attacks with Möbius strip logic
Health secretary seeks to deflect blame over crisis in A&E by accusing Labour of failing to pay tribute to NHS staff
Poor Jeremy Hunt. The health secretary always resembles a young man taking part in a school debating contest who fantasises that he is a really important government minister, running a crucial department. Then he wakes up and realises that he is! It must be terrifying.
On Tuesday he was dragged to the chamber to talk about the crisis in A&E. His figures showed that the situation was getting better. Doctors’ figures, used by Labour, suggested it was getting worse. All of which reminds us – you can never, ever believe any statistics about the NHS. They are all massaged as thoroughly as a Japanese Kobe bull the day before it’s slaughtered.
Mr Hunt, with his piping voice and eager expression, decided to blame Labour. There was a surprise! It was all their fault for making it easy for GPs to avoid out-of-hours work. And to be fair there is some truth in this.
The former Labour health secretary Patricia Hewitt saw her job as giving the medical profession everything it asked for, and then some. For GPs, she filled a dumper-truck with money, pulled the unload lever, and told the doctors to say when.
On the other hand, the coalition has had three years to do something. And the NHS Direct 111 service, which puts you in touch with people who have a smidgeon of medical knowledge – “neither confident nor competent” in Frank Dobson’s words – and who, I’m told, sound as if they would be happier offering you cut-price double glazing. For that reason, their default position is to say something on the lines of: “Oh, I dunno, why don’t you just go to A&E?” Where the patient will be lucky to wait for less than four hours.
Andy Burnham, the Labour spokesman, was in a fine froth. “We asked him to get a grip, and his only response was to tour the TV studios blaming it on the 2004 GPs’ contract!
“Cut the spin and get a grip!” he added, thoughtfully.
Mr Hunt said the 111 service had had teething problems. Labour MPs jeered happily at that. You could argue that, in the same way, someone who’s been smashed in the mouth with a baseball bat also had problems with his teeth.
The secretary of state produced a sort of logical Möbius strip, turned in on itself. After listening to the Labour party complaining for the best part of an hour about the collapse in after-hours care, he announced: “The party opposite have their heads in the sand about the lack of patient confidence in after-hours care.
“We are going to sort out that problem, and if they don’t want us to, they will just have to watch while we do it!”
Or perhaps his inspiration was the artist MC Escher: all those people trudging endlessly uphill, never descending, never arriving.
Oh, and Mr Hunt pulled the old trick of accusing the opposition of failing to pay tribute to the marvellous work done by NHS staff. This is the last refuge of the cornered school debater, and it was used lavishly by Labour when they were in power.
No, Mr Hunt, no one doubts their hard work or their commitment. It’s you and your government they blame.
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Senior NHS figure challenges Jeremy Hunt over causes of A&E crisis
Chief executive of NHS Confederation rejects health secretary’s claim that changes to GP contract in 2004 are to blame
There is no link between the crisis in hospital A&E departments and GPs opting out of out-of-hours care, a leading NHS figure has said – in a direct challenge to the health secretary, Jeremy Hunt.
Mike Farrar, the chief executive of the NHS Confederation, the body representing organisations commissioning and providing health services, questioned Hunt’s assertion that Labour was to blame for a public loss of confidence in alternatives to casualty by agreeing a new contract with family doctors in 2004.
As the political row deepened over overcrowded A&E departments – one that will get worse as ministers consider a number of closure plans – Farrar said: “We do not see a correlation between the changes to the 2004 GP contract and the NHS 4-hour waiting standard for A&E departments.”
Hunt has been keen to differentiate between blaming Labour and GPs themselves, but for days he has been citing the GP contract changes as a main cause of the problem. On Tuesday, he told MPs they had had “devastating impact and that pressures on A&E services were “direct consequences of the disastrous changes”.
The minister also said that last year’s GP patients’ survey showed “only 58% of patients know how to contact their local out-of-hours service, and said that 20% of patients find it difficult to contact their out-of-hours service, that 37% of patients feel that the service is too slow – problems that we are trying to address.”
But Farrar said: “In fact, for the vast majority of the last decade, A&E waiting time standards have been improving. It is in recent years where the pressures have started to bite, and there have not been any discernible structural changes to out-of-hours GP contracts during that time.
“It is clearly evident that there are rising pressures on the whole system. We agree there is a need to improve the co-ordination of out-of-hours care, and see how it can help take the pressures off A&E,” said Farrar.
“We believe real and lasting improvements to out-of-hours care are possible, but only if we put a greater level of investment in to primary, community and social care.”
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Jeremy Hunt’s blundering blaming of GPs makes for bad politics | Polly Toynbee
The health secretary is taking a risk in gunning for family doctors. The public trust them more than they do those in government
The inevitable NHS crisis has begun to rumble even sooner than predicted. Not two months into the great commercialising upheaval, and blood pressure in the NHS is already rising. When a spending tourniquet squeezes both health and social care, A&E always shows the first symptoms. Jeremy Hunt, the health secretary, has some gall in blaming GPs, when the entire NHS plan was designed with the pretence of putting the service into the friendly hands of your trusted family doctor. In the government’s lexicon of blame, GPs have gone from hero to zero in no time. Yesterday’s BMA conference made plain they won’t stand for it.
Money is the immediate cause: the NHS falls over if denied a 2% real increase. Everyone – from Stephen Dorrell, head of the health select committee, to just about every health economist – warned David Cameron. Margaret Thatcher caused eruptions by cutting too hard, as did Tony Blair by spending too little in his frozen first two years – but neither tried such a squeeze as this alongside a tumultuous £3bn re-disorganisation.
Blaming Labour’s GP contract of a decade ago is an absurdity contested even by those who solidly support the government’s plan, such as the NHS Confederation. Alan Milburn, as Labour health secretary, did have the wool pulled over his eyes on the 2004 GP contract, and the BMA struck gold – winning pay for lucrative targets too easy to hit while letting GPs buy off out-of-hours duties too cheaply.
But escape from unsocial hours did solve the acute shortage of GP trainees. Contrary to Hunt’s claim, A&E visits didn’t soar after the GP contract, only increasing by the 1% or 2% expected with an ageing population, according to the government’s own Emergency Care Review. Lest Hunt forgets, Labour left the NHS with virtually no waiting lists for operations or long A&E waits, and patient satisfaction at the highest ever recorded. Hunt’s attempt to blame the GP contract is, even by his standards, an eye-watering, breathtaking economy with the truth.
A&E pressure has risen sharply recently for obvious reasons. GPs are good value as gatekeepers to hospitals – a system envied by continental services where patients take themselves straight to costly specialists. But the government ignored warnings about giving professionals too much power over their own services. While most GPs were indignantly opposed to the privatising reforms, a few entrepreneurial types seized the chance to run care-commissioning groups: nothing stops them sending patients to private clinics that they have invested in. Some GPs never liked competition from Labour’s walk-in and urgent treatment centres, so these are being cut back, with 26 closing altogether – though they prevent far more expensive A&E visits. Lord Darzi’s plan for polyclinics to ease pressure on hospital outpatients was abandoned: GPs prefer keeping their own premises.
Tony Blair, assailed by an angry patient in the 2005 election, obliged GPs to open on a Saturday or at least one evening, and three-quarters did. But this government, when it was wooing GPs, abandoned the monitoring of their hours, since when over half of surgeries have cut opening times. Last year the numbers offering evenings and Saturdays dropped by almost 6%. You may remember that Cameron promised in the Mail just before the election: “You will be able to see a GP in your area until 8pm, seven days a week“. Instead there are too few GPs to cope with a growing need, and many are overworked.
Labour’s successful NHS Direct staffed by nurses was recklessly replaced with 111′s clueless call-centre operators. That swelled numbers referred to A&E by a third. “Teething problems”, says Hunt, but 111 may never win public trust, as 40% abandon their calls to it in some areas. South East Coast Ambulances Service staff say callouts have doubled as inept operators send them out to trivial complaints. Ambulances queue outside A&E, and only half of hospitals hit the government’s lower waiting target: no surprise in the 50% drop-out rate for young doctors in emergency medicine. Patients wait on trolleys in A&E partly because there are 6% fewer hospital beds than in 2010. Consultants warned the Commons this week that occupancy was dangerously near 100% .
Talk of getting people out of hospital and into the community is wildly unrealistic when social care is deeply cut. Last year there were 118,000 “bed-blockers”, people waiting in hospital for lack of community care or a home to go to. Protecting the NHS budget comes at the price of a massacre of local authority spending, so the frail getting inadequate 15-minute care visits end up in a crisis needing hospital treatment. Benefit cuts that shunt at least 660,000 families away from their GPs into distant temporary housing add to A&E visits.
Sir David Nicholson, NHS England head, was the last glue holding together this organisational chaos, so losing him to the wolves of the Mail, Telegraph, Times and Sun should deeply alarm the government. He was hounded for the Mid Staffs scandal, though was not blamed in the Francis report. His real sin was to know (and almost say) that Lansley’s plan was a disaster in the making, but instead of blowing the whistle he tried to make it work. Fragmenting the service with private competition is no way to secure the NHS in hard times. The only hope is by binding health and social services budgets together, as Labour proposes. Easy to say, hard to do.
Jeremy Hunt takes a risk in gunning for GPs, walloping them with a “rigorous” new chief inspector. What chutzpah to talk of cutting their red tape so they can “care”, just as hefty commissioning duties are foisted on them. How will he give GPs back out-of-hours duties, just as clinical commissioning groups put them out to private tender? Hunt was put there to stop NHS noise and halt closures before the election, but this blundering blaming of GPs is bad politics. Who will the public trust? History is not on his side.
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