The new contract is not so bleak. All emergencies must be seen on the
day, and routine cases within 48 hours (GP) or 24 hours (GP or nurse).
PCTs become responsible for OOH care commissioning, whereas at present
it is still down to GPs organising 24hr/7 day a week cover. The general
feeling is that many GPs will give up £6,000 and their 24 hour
responsibility, but agree to cover some sessions.
Their may not be enough GPs to fill all sessions (speculative) so that
there will be a need for involving other healthcare professionals of
which there are many pilot schemes throughout the Country. In Kent, we
are looking at the combined skills of paramedic, nurse in a response car
to cover a mixture of GP home visits, night nursing calls and additional
first response capability which hopefully will be a cost efficient and
effective model. It starts on Monday so fingers crossed!
Other areas have primary care centres which are nurse led with GP back
up - estimates have already indicated that appropriately trained nurse
practitioners may be able to treat up to 75% of "unscheduled" primary
care and this figure may be higher with on-line medical advice.
Obviously the OOH Plan of David Carson also talks of an increased number
of primary care centres, including housing some within A&E. Some GPs may
even look at a career in OOH primary care - priced at a minimum of £50
per hour it will not be difficult to earn £100k. Tricky choice, the
price paid by the government to keep in hours care is £6k, the earnings
for doing sessions OOH at commercial rates full time £100,000.
GPs will have effectively dropped their OOH responsibility - perhaps
something the consultants could look at getting paid for 9-5/ 8-6 or
whatever and pulling together OOH or when work intensity is low covering
2-3 A&E depts at fulltime rates?? Obviously area dependant and quite
appreciate will be impossible in some centres.
Different areas will be looking at different solutions in primary care
and no doubt there will be some unique individual solutions to the
problem...which is all still speculative!
Jeremy Mayhew - Kent Ambulance
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of
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Sent: 21 June 2003 21:59
To: [log in to unmask]
Subject: Re: Primary care in A&E
Although I fear the major increase likely to come our way with the new
GP
contract (and who will wait 48 hours to see a GP when they can see us
within a guarunteed 4 hours anyway)I was slightly reassured after a chat
with one of the local GP's today on my way out via the GP co-op, he is a
sensible chap as well as being my own GP, He was saying that the devil
as
ever is in the detail. This year they lose 6K if they drop OOH but this
is
not a permanent rate and next year the cost may be higher so there is a
significant threat that if too many drop out there will be a big hike in
the cost of that drop out. He reckons the PCT will use this to maintain
the
cover.
I do hope so because we have a good group of GP's in our area in general
and without them I will be packed off to the funny farm in very short
order!
Andy V
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