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.

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