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Last Updated: Monday, 30 January 2006, 11:19 GMT
Mixed reaction to NHS care plans
Image of an injection
Nine in 10 NHS patients are seen outside hospitals
There has been mixed reaction to the government's plans to shift the emphasis of care from hospitals to the community.

Ministers want to see more care carried out by GPs, nurses and other health professionals working outside hospital.

Doctors have welcomed the shift, but said there is still a shortage of numbers, while patient groups said there are large gaps in care.

Opposition parties said the measures were a move "in the wrong direction."


London-based family doctor Laurence Buckman, a member of the British Medical Association's GPs committee, said many of the initiatives such as care campuses, which will provide a mix of GP and hospital care, and opening up health clinics in supermarkets, were interesting but not necessarily in the best interests of patients.

He said: "The misunderstanding of what doctors and patients do for each other, starts with the idea that you can just pop in and see somebody.

"Most patients and doctors have a relationship that lasts beyond the current reason that they're in, they're meeting together.

Every effort must now be made by the NHS to engage front-line clinicians - something that has not happened with great success to date
Dr Mayur Lakhani, chairman of the Royal College of GPs

"And continuity of care, and continuity of record as well is very important. The guy in the supermarket who sees a patient once, isn't going to know their past history."

Dr Hamish Meldrum, chairman of the BMA's GPs committee, also welcomed the measures, but said extra doctors were needed. It is estimated another 10,000 GPs - a third of the total - will be needed to fill gaps in care and replace retiring doctors in the coming years.

Dr Meldrum said: "The main problem is lack of GPs. We are very much wanting to make ourselves more accessible, but we need to expand the numbers."

And Dr Mayur Lakhani, chairman of the Royal College of GPs, said that while the white paper was a "major step forward", it presented a formidable challenge.

"Winning the hearts and minds of doctors and nurses is the key to making this white paper happen.

"Every effort must now be made by the NHS to engage front-line clinicians - something that has not happened with great success to date."

He added the RCGP particularly welcomed the emphasis on health inequalities.

"All sections of our society deserve high quality comprehensive care. The best way to achieve this is to build on the strengths of general practice."


Joyce Robins, co-director of Patient Concern, accused the government of promising things it could not deliver.

"This is very much a popularity paper as I see it.

"The government have listened to what patients want, patients want treatment nearer their home, they want good access to GPs, they want a walk in centre on every corner - I want to be a millionaire, unfortunately it's probably not going to happen.

"We haven't got the people. The main complaints from patients are that they cannot see a GP. Why can't they see a GP? Because there aren't enough of them.

"This isn't simply deprived areas, this is everywhere."


Jonathan Ellis, of Help the Aged, said the proposals could benefit older people - but only if new resources were made available.

"The greater focus on active ageing, prevention of ill health, better choice and access to community health and social care services is very much welcomed.

"However, we are still cautious as to the extent to which the shift towards a preventative style of health and social care delivery will actually be achieved."

Betty McBride, of the British Heart Foundation, welcomed the drive for closer links between health and social care, and the aim of giving patients greater independence and the resources to care for themselves.

However, she said: "The BHF calls urgently for the government bring more clarity to who does what and who pays for what."

Phil Gray, of the Chartered Society of Physiotherapy, said the proposals offered an opportunity for "revolutionary change and considerable cost savings" - but only with substantial new investment.


Jessica Allen, a health expert at the Institute for Public Policy Research and author on a report on primary care reforms, said GPs should be paid more to work in the most deprived areas.

"More GPs in deprived areas and more community based healthcare, outside hospitals, is an effective way of reducing health inequalities.

Niall Dickson
Niall Dickson said the aims were correct

"At present most GPs are paid a salary or are funded according to historical patterns, rather than on the basis of the health needs of their population."

And she added: "The white paper needs to commit resources to better information, advice and transport.

"Almost one and a half million people a year miss, turn down or do not seek healthcare because of lack of access to transport."

Niall Dickson, chief executive of the King's Fund, said it was vital to try to reduce pressure on the hospital sector by cutting unnecessary admissions.

"The aims of this White Paper are absolutely right. The difficulty is that the system already feels under quite a lot of strain at the moment.

"With these financial difficulties on the ground it may be quite difficult to get the incentives right."

Mr Dickson said the key was to target reforms so that they benefitted those in most need.

"It is no use simply saying we will have a health MoT for everybody in the country. That would simply get an awful lot of worried well people into surgeries being subjected to tests that are unnecessary."

Stephen Thornton, chief executive of the Health Foundation, said: "Primary care services have proved extraordinarily resistant to reform over the years.

"With or without more choice and markets, the true test of the government's plans will be whether they create a genuine partnership between patients and their GPs.

"That means involving patients in treatment choices, improving the way doctors communicate with their patients and providing support for patients in maintaining a healthy lifestyle."


Andrew Lansley
Mr Lansley has accused the government of moving in the wrong direction

Shadow Health Secretary Andrew Lansley said the plans did not add up.

"The white paper leaves many questions unanswered. Many Primary Care Trusts are cutting back precisely the community-based services on which the care plan depends.

"How can palliative care be improved if Macmillan nurses are transferred to other duties?

"How can consultants offer out-patient clinics and minor operations locally, if 90 community hospitals are threatened with closure?

"How can young people with mental health problems cope if their services are cut back?

"How can she criticise GPs for lack of access, when it is the government's contract, two years ago, which led to Saturday morning surgeries closing across the country and the government¿s targets which turned GP appointment systems into chaos?"

Liberal Democrat health spokesman Steve Webb MP said it was hypocritical of ministers to talk about more care in the community when the financial crisis in the NHS - one in four trusts finished last year in deficit - was threatening services.

"What is needed is reform based on evidence not on opinion polls. With money being so tight in the NHS it is vital that money is not wasted on gimmicks.

"A health MoT for everyone might sound attractive, but is highly unlikely to be cost effective.

"There is a real danger of surgeries being swamped by the 'worried well' while people in real need have longer to wait."

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