GPs take on extra role for frailest patients

Jeremy Hunt said he hoped this would be part of a "much bigger change"

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The million most frail patients in England are to be identified and given a named GP to co-ordinate their care.

The move has been agreed by the British Medical Association and NHS England in talks over next year's GP contract.

Ministers had been pushing for doctors to take greater responsibility for the most vulnerable patients in society to relieve pressure on hospitals.

An analysis by NHS England showed many of the winter pressures on A&E came from frail elderly patients.

Contrary to common perception, it found that summer was the busiest time for A&E units in terms of numbers, but winter was when the difficulties arose because of the rise in the numbers of elderly patients needing care.

A third of emergency admissions are among the over-75s - many of which could be avoided if they received earlier and better care in the community.

This is where the agreement with GPs - which will kick in next April - will help, ministers say.

'Old-fashioned' approach

Under the terms of the deal, doctors have agreed to carry out a trawl of their registers to identify the frailest 2% of patients.

Dr Richard Vautrey from the BMA: "This will mean GPs will spend less time focusing on box ticking... and more time on the needs of their patients"

This is likely to include people at the end of life, in care homes and those who are frequently in and out of hospital.

They will then take responsibility for overseeing their care across the NHS and social care sectors.

Start Quote

This will free up GPs to spend more time focusing on treating patients”

End Quote Dr Chaand Nagpaul British Medical Associaton

The aim is to create a much more proactive services whereby their needs - from home adaptations to intensive nursing support - are met much more quickly.

They will also need to offer these patients same-day telephone consultations as well as checking up on them after discharge from hospital.

This contrasts with what the government and doctors' leaders agree is the more reactive service many patients are currently getting.

And those over 75, around four million in total. will be given a named GP - at the moment patients are registered to a practice rather than individual doctor. It is hoped this will lead to greater continuity of care for those patients who visit GPs the most.

'Phone frustration'

Health Secretary Jeremy Hunt hailed as the return of the "old-fashioned family doctor" and an end to the current "box-ticking" culture.

"We are bringing back the named GPs for the vulnerable elderly. This means proper family doctors able to focus on giving elderly people the care they need and prevent unnecessary trips to hospital."


GP practices are small businesses - and contracts are held by the practice, rather than individual GPs.

Funding comes from a number of different sources and is weighted so a practice with, say, lots of elderly people on its books will receive more than one which looks after a relatively young and healthy population.

The main source of income, accounting for around half the funding a practice receives, is the 'global sum'. This is a payment based on the estimated workload from the patients registered.

Next comes QOF - the Quality and Outcomes Framework which is at the centre of these latest contract changes.

This is in effect a points system where practices accumulate a score from meeting requirements such as monitoring how many of their patients have a certain condition or ensuring checks such as blood pressure readings are carried out on a regular basis.

These contract changes would cut QOF - and move funding of around £290m into the global pot.

Other funding streams include extras services such as flu and childhood jabs, which are not part of the contract but which most offer, are funded separately.

Seniority payments for long-serving GPs, and funding for premises make up the rest of a practice's income.

Out of this pot, a practice has to pay staff costs and other bills - as well as GPs' pay.

Those GPs who have responsibilities for practice management earned on average across the UK £103,000 in 2011/12.

Salaried GPs, who do not, could this year earn a maximum of £81,969.

In return, doctors have been freed from what they considered some of the most burdensome aspects of the form-filling they had to do for their performance-related pay.

This means requirements such as having to annually ask men with diabetes if they experienced erectile dysfunction at their check-ups will be removed, as will the need to ask those with high blood pressure in detail about their activity levels, with what doctors say were often irrelevant questions.

But Labour's Shadow Health Secretary Andy Burnham told BBC Radio 4's Today programme: "The bottom line is under this government, it has got harder to get a GP appointment. And nothing in today's announcement will correct that.

"People will still face the frustration of phoning the surgery at nine o'clock in the morning, being told there's nothing available for days and then some having to turn to A & E."

He added: "David Cameron cut Labour's scheme of evening and weekend opening and the guarantee of seeing a doctor within 48 hours," Mr Burnham added.

"This announcement will not put an end to patients phoning the surgery at 9am and finding it impossible to get an appointment - many of whom, not happy with a phone consultation, will still turn to A&E.

"People will fail to see how this package delivers the public commitment David Cameron gave last month to keep GP surgeries open from 8am to 8pm."

Dr Richard Vautrey of the British Medical Association's GPs committee, told the BBC: "It will help to a degree. It certainly won't be a panacea but it will start to focus on the needs of the most vulnerable and those patients who do go into hospital more frequently.

"And it will give GPs that bit more time to be able to spend with their patients to try and meet their needs."

Story updated at 12.50pm following clarification of figures.

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