Health secretary’s remarks about GPs are “morale sapping,” says royal college

BMJ 2013; 347 doi: (Published 10 September 2013) Cite this as: BMJ 2013;347:f5545
  1. Ingrid Torjesen
  1. 1London

England’s health secretary, Jeremy Hunt, has announced that one of the changes he wants to make to the current GP contract is to give every vulnerable elderly patient a named GP who would be responsible for their care. He said that under the present system hospital emergency staff know some patients better than their own GPs do.

His remarks were condemned by Clare Gerada, president of the Royal College of General Practitioners, as “disheartening and morale sapping.”

Outlining his plans for the future, Hunt said that the 2004 general medical services contract for GPs removed the historical system whereby every patient was registered with an individual, named GP, replacing it instead with a system where patients were registered only with a practice. The aim was to make it easier for patients to get an appointment with a GP. However, Hunt has suggested that the removal of this personal link was a mistake.

In an article in the Daily Telegraph on 10 September Hunt wrote, “Sadly the 2004 contract changes undermined the personal link between [GPs] and their patients, as well as imposing a whole range of bureaucratic burdens. Labour’s intentions, as ever, were good. But the effect was to make it harder for GPs to be family doctors and give them less time with patients.”1

As a result, he added, “Too many old people feel there’s no reliable alternative to hospital . . . It’s become easier to go to A&E [accident and emergency] and harder to go and see a GP. In fact, we’ve got to a point where A&E staff know some patients better than their own GPs.

“We need a much better way for vulnerable old people to journey through the NHS. They need someone from the service to be keeping tabs on them and championing them through the system all the time—and making sure they are a name, not a number.”

The Department of Health first mooted that it wanted vulnerable elderly patients to have a named clinician responsible for their care in the community—in the same way as patients in hospitals are under the care of a named consultant—when it published its proposed NHS mandate for 2014 in July.2 The document says, “Although this clinician may not provide the care directly themselves, they would be the person with whom the buck stops and would be an identifiable point of contact for a patient or their family.”

Hunt has now made it clear that he wants this person to be a GP. “I would like that responsible person to be my GP—but of course they will need support from many others including our dedicated district nurses,” he wrote in the Daily Telegraph.

Gerada said that although Hunt was right to make the care of vulnerable older people a priority, given the ageing population, GPs would object to his comments.

“No other part of the health service delivers the personalised care and continuity of care provided by general practice—care that is highly valued and trusted by our older patients,” she said. “To accuse family doctors of neglecting these patients, both in the community and when they go into care homes or hospital, is untrue and unacceptable.”

Gerada said that older patients were consulting GPs with increasingly complex and multiple chronic conditions and that, with dwindling resources for general practice, four fifths of family doctors were concerned that it would become increasingly difficult to deliver continuity of care to older people.

“We want to do more for our patients, but we simply do not have the capacity to take on any more work, without the extra funding and resources to back it up,” she said. “Once again hardworking GPs are being attacked when the government should be supporting them and giving general practice its fair share of NHS funding. Without that we cannot provide the quality of services in the community for all our patients that we all want.”


Cite this as: BMJ 2013;347:f5545


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