GPs urged to restrict duties in health market

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The medical care of thousands of elderly, frail people in nursing homes is in question, after the British Medical Association yesterday advised GPs that these patients need no longer be regarded as part of family doctor core services.

Nursing home residents are traditionally under the care of GPs at a nearby practice, and are an accepted feature of their primary care responsibilities. However, the residents take up far more time than other patients, requiring 10 times more consultations than the national average, and often needing specialist care.

Under new voluntary guidelines published by the BMA, GPs are invited to put health authorities on notice that from 1 April next year they will no longer be able to take on new nursing home patients. This would oblige health authorities to pay for care from other providers, such as community health trusts or individual GPs specialising in geriatric care.

The guidelines are aimed at "ring-fencing" family doctor core services - those services GPs are obliged to provide - following the publication of a White Paper last month in which Stephen Dorrell, the Secretary of State for Health, outlined his vision of expanded primary care to relieve the burden on acute hospitals.

But the guidelines also recommend that several services now regarded as "core" require specific contracts in the future and should be charged for as "extras". They include minor surgery and child health monitoring.

Other recent developments in primary care now being taken on by GPs are defined specifically as "non-core" in the guidelines, which advise that they become the subject of explicit contracts.

These include pre-operative assessment and post-operative care, sub-fertility treatment, drug dependency arrangements, involvement in drug trials and caring for mentally ill patients under supervision orders.

The present open-ended GP contract defines core services as "personal medical services of the type usually provided by general practitioners". But Dr Ian Bogle, chairman of the association's GPs committee, said the essence of the family doctor service was threatened by increasing demand with longer waiting times for an increasing variety of services "We're approaching the concept of core services in a positive way ... to protect the family doctor service for patients. We do that by clearly defining the that they can expect to be done as part of the family doctor service."

Speaking at the launch of the BMA document, "Core Services: Taking the Initiative", yesterday, Dr Bogle said: "We advise doctors to advise health authorities with plenty of warning that they have not the skills and manpower to take on new patients in nursing homes. We would then expect nursing homes and health authorities to take account of the views of GPs ... and to arrange contracts with providers."

A spokeswoman for the Department of Health said the BMA document would be "read with interest" and the recommendations taken on board.