Diagnosis remains grim

GPs are the cornerstone of primary health care, as well as the
gateway to the rest of the tottering NHS edifice. So it should come
as no surprise that tinkering with their contract is having some
unexpected and not entirely welcome effects.

In a nutshell, family doctors have been freed from their legal duty
to provide 24-hour care for their patients. And they can now opt
out of providing specialist services for asylum seekers, homeless
people or alcoholics, too. Responsibility passes to primary care
trusts.

These changes will relieve the pressure on GPs. But there is
growing disquiet about what they mean for vulnerable people. Out of
hours is a case in point: in future, emergency primary care is
likely to be based in general hospitals and accessed through a
specialised call centre. The current out-of-hours provision is far
from ideal, but the new arrangements raise the spectre of
desperately ill people being left hanging on the phone, or stuck
without transport miles away from the only source of emergency
medical help.

At the same time the British Medical Association has accused PCTs
of creative accounting – “rebadging” funds to pay off debts or
boost other services rather than investing in new specialist
services. This is a serious error of judgement, as well as
indefensible political cynicism, since the result of a lack of
specialist services will be increased pressure on mainstream
primary care and more hospital admissions.

PCT budgets face being squeezed from other directions too as local
councils warn of service cuts as they try to make Sir Peter
Gershon’s efficiency savings. Trusts face the unappealing prospect
of having to bail out local authorities to maintain any sort of
combined investment in early intervention. Ultimately, it is hard
to see how any of these changes represents an improvement for
service users.