Exclusive: David Cameron's £50m package will fund 'bespoke' GP services for elderly patients

PM aims to shift care away from overworked A&E and back to the community

More than 1,000 GP surgeries will start offering appointments in the evening and at weekends, David Cameron will announce tomorrow. There are also schemes for consultations by Skype, and personalised care plans for the elderly.

The Prime Minister will unveil a £50m "Challenge Fund" package designed to stem anger over the failure of family doctors to provide round-the-clock appointments, with patients forced to book many weeks ahead or to compete with others for an emergency on-the-day consultation.

At the heart of the plan is a "bespoke service" for more than 750,000 elderly patients, which is designed to ease pressure on hospitals; a large proportion of beds are being taken up with over-75s, one of the fastest growing age groups in the population.

Because of a lack of accessible care at GP surgery level, elderly patients are often forced to attend A&E departments, and are then caught up in the system, often being discharged later than they should because there is no community aftercare service. The Independent on Sunday revealed last month that nearly one million people are waiting longer than four hours to be seen by a doctor at A&E. Andy Burnham, the Shadow Health Secretary, has warned that this log-jam has been created by cuts to local government social care budgets, meaning elderly patients who could have been treated at home for minor injuries and ailments are instead being admitted to A&E.

The IoS understands that Mr Cameron will unveil personalised care plans for the elderly, with doctors, practice nurses and other health-care professionals reviewing them on a regular basis to anticipate problems and prevent admission to A&E.

Elderly patients will be given prioritised appointments, and doctors will be required to make regular visits to nursing homes. More than six million people will be over 75 by the end of the next decade, and cases of illnesses such as dementia are increasing.

The £50m is being targeted at 1,000 surgeries that offer greater access to all patients, not only to elderly people, including appointments at weekends and between the hours of 8am and 8pm. There will be greater scope for consultations by email and Skype, while the Government will make it easier for people to move surgeries, order repeat prescriptions by email, and force GPs and hospitals to work more closely together to prevent readmission to A&E.

Mr Cameron will say that the priority must be to shift care from hospital to the home. But critics will question why this action has not been taken sooner. Last autumn, Labour predicted there would be an A&E crisis this winter, but Mr Cameron last week claimed that crisis had never materialised. However, much of England remained mild, and cold-related illnesses and injuries associated with falls on ice have been far fewer than in previous years.

At his party conference speech last October, the Prime Minister raised the prospect of appointments by Skype to ease pressure on GPs under the Challenge Fund plan.

Since the Labour government renegotiated GPs' contracts in 2004, family doctors have been free to opt out of providing appointments in the evening and at weekends. Coverage is patchy across the country, and a poll for GP magazine last year found that 80 per cent of family doctors rejected returning to providing out of hours appointments. The British Medical Association has opposed providing greater cover without more funding. The £50m to be announced tomorrow represents a tiny proportion of the NHS budget, and the 1,000 surgeries represent around one in eight in England, raising questions over how much cover the new funding will actually provide.

A Whitehall source said it was "crucial" to free up GPs so that they can spend more time with their sickest patients. "By becoming more proactive we hope to ease the pressure off GPs so they can focus on the older patients with more complex needs. The aim is to fundamentally shift care away from hospitals to people's homes where, with the right amount of support, they can better manage their conditions rather than be admitted to hospital."

At the Tory conference last year, Mr Cameron said: "Millions of people find it hard to get an appointment to see their GP at a time that fits in with their work and family life. We want to support GPs, to modernise their services so they can see patients from 8am to 8pm, seven days a week.

"We also want greater flexibility, so people can speak to their family doctor on the phone, send them an email or even speak to them on Skype," he added.

History of broken promises

2004

General Medical Services contract introduced. Surgeries, not GPs, have contracts with NHS. Allows GPs to opt out of out-of-hours services.

2006-07

Private companies begin running GP surgeries.

2009-10

Additional funding guaranteed for GP practices in deprived areas to tackle "health inequalities" between rich and poor.

2013

Some 211 regional Clinical Commissioning Groups (CCGs) set up to replace Primary Care Trusts. One GP per local surgery sits on CCG governing body that allocates funding, raising conflict-of-interest concerns. NHS Direct closed down after financial difficulties, replaced by NHS 111, run by private firms. Greater funding to deprived areas removed, NHS instead pours extra money into areas with high levels of elderly people. Plans to keep surgeries open seven days a week, 8am to 8pm, announced.

2014

The BMA warns funding cuts would remove guaranteed income for small practices, closing 98 rural surgeries. It says the bungled introduction of NHS 111 is likely to cost millions.

William McLennan and Joe Krishnan

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