GPs should offer same-day appointments to patients to stem the flood of people into accident and emergency wards and avoid a repeat of last winter's crisis, the health secretary has said.
Jeremy Hunt outlined a series of long-term measures and short-term fixes to deal with rising numbers of patients who end up in A&E. The number of people going to emergency departments in England had risen by 32% in the past decade, Hunt said, which meant the service needed "fundamental changes".
At the weekend Labour revealed that in England major A&E departments had missed government targets in 41 of the past 52 weeks. Hunt said it was "entirely possible to meet the A&E targets but it will be tough this winter".
The government's analysis is that patients are going straight to A&E because they are unable to access their GP or do not trust the old NHS call-centre system. The result is that hospitals become clogged up with patients, especially elderly people, with the average length of stay for those aged over 80 now more than 14 days.
At the heart of the changes will be a renegotiation of the GP contract, which Hunt said had "eroded the personalised service" to the extent that "some A&E staff know some patients better than their own GP".
GPs will be obliged to offer same-day access and appoint a clinical care co-ordinator for the over-65s, who make up 17% of the population but occupy 68% of NHS beds.
GP leaders said it was nonsense to suggest emergency doctors knew patients better than primary care physicians. Clare Gerada, chair of the Royal College of General Practitioners, said that rather than same-day access, "GPs prefer timely access to treatment. Sometimes waiting is the best thing to do for patients. I think the government is covering up for the fact it spent £3bn disorganising the NHS with its changes and found it has not worked."
To cover the next two years there will be a previously announced £500m winter pressures fund, which will go to 53 NHS trusts to pay for extra consultants, district nurses and teams to support early discharge of elderly patients into the community. Hunt denied this was a "bung for failure", saying the hospitals had been identified by regulators as being "most at risk of not giving good service to patients".
Hunt said there would have to be changes to ensure the NHS could cope. Sir Bruce Keogh, the NHS medical director, said a fifth of A&E departments did not have "appropriate facilities for children. One in seven are missing the specialists required by the college of emergency medicine, and there are issues with consultant cover especially in the early evening."
A key part of improving A&E, Hunt said, would be better IT and the sharing of patient data. In future, patients will be expected to first phone the new 111 service, where call-centre clinicians will be able to access GP records and advise individuals on whether to go to hospital. If patients do need to go to A&E, they will be met by doctors who will also have access to their medical histories – a third of emergency wards will be able to get hold of GP records online by this time next year.
There will also be an emphasis on doctors and nurses taking their own advice, with a target of 75% of healthcare professionals getting vaccinated for the flu. In some hospitals the figure is as low as 8%.
Labour said NHS data revealed that A&Es had had their worst summer in a decade, and that close to one million patients in the past year had had to wait for more than four hours to be seen. Andy Burnham, the shadow health secretary, described Hunt's plans as half-baked.
"Jeremy Hunt tries to blame the 2004 GP contract but conveniently ignores the fact that A&E performance improved between 2004 and 2010. The truth is it is they who have let GP practices stop evening and weekend surgeries and ended the guarantee of appointments within 48 hours," he said.
