GPs sceptical about new contract designed to reduce A&E pressure

GPs get fewer targets and more responsibility for over-75s but question practical effect as spend on general practice declines

GPs in England will no longer be required to offer patients appointments lasting at least 10 minutes under a fresh contract agreed with ministers.

In a wide-ranging deal, GPs will have to accept "named doctor" responsibility for all patients aged 75 and older; phase out boundaries that prevent the public from signing up to any doctor from 2015; and commit to police the care their patients receive from out-of-hours providers.

But doctors won the right to organise their own appointments – at present NHS England says consultations last on average for around 12 minutes.

While about £290m has been added to funding, the Royal College of General Practitioners (RCGP) and the National Association for Patient Participation (NAPP) warned that the proportion of NHS money spent on general practice has slumped across Britain over the past nine years to the lowest percentage on record.

New figures showed that in 2004-05, 10.33% of the NHS budget was spent on general practice. By 2011-12, this figure had declined by almost two percentage points to 8.4%.

GPs say the fall in funding is compromising the standard of care they can offer patients, leading to longer waiting times and increasing pressure on hospitals.

GP leaders were now calling for the trend to be reversed. The chair of the RCGP, Maureen Baker, said: "The flow of funding away from general practice has been contrary to the rhetoric and has happened in the absence of any overall strategy as to how we spend the NHS budget.

"We need to increase our investment in general practice as a matter of urgency, so that we can take the pressure off our hospitals, where medical provision is more expensive, and ensure that more people can receive care where they say they want it – in the community."

She called on the government to increase spending on general practice to 11% of the NHS budget by 2017.

But the government maintained that the changes agreed in the new contract would reduce pressure on the NHS – especially in the vexed area of A&E.

The health secretary, Jeremy Hunt, said that every person aged over 75 would have a named GP who would know their medical history, ensuring they receive better and faster medical advice and so would have less need to resort to A&E departments. He also said the coalition government was scrapping 40% of GP targets to enable doctors to provide personalised care for patients.

GPs told the Guardian that any reduction in "box ticking" was welcome but questioned whether it would happen, given new demands being placed on them.

Dr Ketan Bhatt, a GP in Hertfordshire, said his feeling was that "the devil will be in the detail", which would become clearer next year: "It's good news if it reduces the box-ticking exercise that the government has reduced GPs to. This has demoralised GPs and no doubt reduced patient satisfaction. If this means I can focus more on the patient and less on the computer screen, then great."

He said named GPs for over-75s was a good idea in theory but questioned how it would work in practice, and rejected the idea that the changes would reduce congestion at A&E departments.

"What does having named responsibility mean?" he asked. "Does this mean out-of-hours people will call that GP at 2am to ask what to do? Does it mean GPs will be dealing with issues that social services should be dealing with, thereby reducing clinical time? Often, novel ideas from the government mean more tick-boxing in a different format."

Bhatt added: "The suggestion is that people go to A&E because the GP is shut. That is not true. People go to A&E because they think they are seeing the best or will be seen quicker – yet the wait is often four hours.

"What would reduce the pressure is if triage in A&E directed people back to their GP or out of hours. Or if there were GPs tagging along with paramedics on 999 calls."

In south Worcestershire, where GPs have already been going out with paramedics, GP Dr Chris Renfrew said it had made a big difference in terms of relieving the pressure on A&E. He suggested that named GPs could play a part in conjunction with other initiatives.

"One hopes that the increase in specific named GPs, in particular with respect to the elderly, may well manage to reassure those who become sick, instead of going straight to A&E," he said.

Dr David Fair, in York, expressed views more akin to those of Bhatt, proclaiming that he was very cynical about the changes. He too questioned how the named GP would work out-of-hours and said it would not reduce pressure on A&E services. "I don't see how it can," he said. "No one has put together a coherent argument about how it's supposed to make a difference."

Fair also questioned whether the reduction in targets would have a tangible effect. "There may be a reduction of me doing this tick-box stuff," he said. "But I don't know whether that can be channelled or swapped into being the named GP of hundreds of thousands of old people."

Dr Matthew Taylor, in east Cheshire, said that Hunt's admission, on Friday morning, that over-75s who are entitled to a same-day conversation with a GP under the new contract might not speak to their named GP meant there would be little change in practice.

"That's no different to now," he said. "All our patients have a named GP but it doesn't mean they'll see them. This idea is not going to make any difference to pressure on A&E … Most GPs feel that we are being pushed to do more and more. We will do the best with whatever system we are given."


Randeep Ramesh and Haroon Siddique

The GuardianTramp

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