Doctor not on call

GPs have never fitted easily into the framework of social care.
Notorious as absentees from child protection meetings and reluctant
to attend patients in care homes, for example, they are perceived
as a law unto themselves. The new GP contract, hailed as the most
ambitious attempt to reform services in the NHS since its inception
in 1948, might have been expected to improve matters. In fact, it
could make things worse.

The problem is that GPs are asked to “opt in” if they want to
provide more than a basic level of services. Many will elect not to
provide “enhanced services”, such as out-of-hours services and
medical and rehabilitation services for drug and alcohol misusers.
The groups likely to miss out are among the most vulnerable in our
society: older people, children and homeless people, as well as
substance misusers.

It is true that primary care trusts must find alternatives if GPs
refuse to provide the relevant services. But alternative facilities
are likely to be provided more expensively and less effectively in
hospitals, possibly well away from people’s own communities. It is
hardly the bold new vision of primary health care we had been led
to expect.