Under changes to their contract which have been agreed with NHS England, GPs will oversee personalised care plans integrating all services, so the frail and elderly are better cared for in the community, reducing hospital admissions.
Responsibilities will include coordinating care for elderly patients discharged from A&E and regularly reviewing emergency admissions from care homes to avoid unnecessary call-outs in future. GPs will also be responsible for monitoring and reporting on the quality of out-of-hours care.
Earlier this week Sir Bruce Keogh published his first report as part of a review of urgent and emergency care in England. In the report, Sir Keogh calls for “a system-wide transformation of urgent and emergency care services” to deal with the increasing pressure on these services.
Out of five million emergency admissions last year, one-third were people over 75, and more than one million could have been avoided.
Figures also show that many people who die in hospital have no clinical need to be there. Better coordinated support in the community can prevent unnecessary hospital admissions for those at the end of life, and allow people to die in a place of their choosing.
Heather Richardson, National Clinical Lead at Help the Hospices, said: “We welcome this move to ensure named GPs have greater responsibility in coordinating around the clock care for their most vulnerable patients. They include people coming to the end of their lives who require well coordinated care, with easy access to professionals who can respond quickly to their changing needs.
“Too many people facing the end of life do not get the care they need at the right time. Hospitals are often used as a stop-gap for these patients when community-based care provided or supported by hospices would be more suitable for their needs, and more in keeping with their preferences.
“This development will help provide more personalised, better targeted care for older patients as well as helping reduce unnecessary hospital admissions, which will be more cost-effective in the long term.”
Imelda Redmond CBE, Director of Policy and Public Affairs at Marie Curie Cancer Care, added: “Marie Curie welcomes the announcement today that will see named GPs co-ordinate care for people over 75. We know from our own patients and their families that GPs make a vital difference for patients, ensuring that they can access the care and support that they need swiftly.
“This is especially true for patients who are at the end of life. Most people who are terminally ill will spend the last year of their life under the care of their GP, with the majority of their palliative care provided under the direction of their GP. Having a named GP that is responsible for the care of a patient with palliative care needs will help ensure they receive the right care, in the right place. GPs are key to ensuring that people nearing the end of life are identified early and can enable better planned and co-ordinated care in line with their needs and wishes.
“At a time when A&Es are already under immense pressure, we hope today’s announcement will mean the high number of avoidable emergency admissions for elderly people with palliative care needs can be reduced by ensuring the right care packages are in place.”
The new contact also means a reduction in the number of QOF (quality and outcome framework) indicators by more than a third, freeing up more time for GPs, with more focus on the patient’s overall needs.
Practices will also be freer to recruit patients from outside traditional boundaries, giving patients greater choice, informed with more information, and it will be compulsory for surgeries to offer appointments and repeat prescriptions online.
Commenting on the announcement, Dame Barbara Hakin, Chief Operating Officer and Deputy Chief Executive at NHS England, said: “As a GP myself for many years, I know the importance of being able to do what we have been trained for – to use our professional clinical judgement to provide care and treatment that meets all aspects of a patient’s needs.
“We know that patients who receive a proactive and coordinated health and social care service are less likely to need to be admitted to hospital – in fact a fifth of hospital admissions could be avoided if this happened every time, and we know that this is particularly important for the most vulnerable patients with complex needs where properly coordinated care makes such a difference.
“With their unique knowledge and position, GPs are ideally placed to ensure patients receive one coordinated service, whatever their needs. This is a particularly important in light of the proposals outlined by Professor Sir Bruce Keogh last week. We need to help GPs and give them the headroom to address these important issues for patients.”
The Care Quality Commission’s chief inspector of general practice, Steve Field, is to develop an easy-to-understand ratings system based on four categories: Outstanding, Good, Requires improvement, and Inadequate, and GPs will have to publish their ratings in waiting rooms.
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.
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