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Practices should reclaim responsibility for 24/7 care, says NHS Alliance

General practice should reclaim its central responsibility forout-of-hours (OOH) care, the NHS Alliance argues in a major new primarycare report.

While not suggesting practices provide all OOH carethemselves - which the report says would be "impossible and unsafe" -the Alliance does urge that practices take responsibility for OOHservices through practice-based commissioning (PBC).

Dr Michael Dixon, NHS Alliance chairman, said: "The decisions aboutwho should provide what services need to made locally, as close to thepatient as possible, by GP practice-based commissioners supported bytheir PCTs and patient groups. And these are the people who shouldmonitor the service as well.

"We have to build care around thepatient, instead of expecting the patient to navigate a system that isconvenient to the service."

The suggestion for reclaiming OOH care is made in In Sickness and in Health,a new NHS Alliance report published today (10 April 2008), whichadvocates the creation of a new system of integrated health servicesdesigned around the patient.

Speaking at the launch of thereport, Dr Dixon said: "For many patients, out-of-hours may as well beout of space", arguing that OOH provision is now so complex it is hardfor patients to know who they should call and where to go.

Thereport authors argue that choices of OOH care currently commissioned byPCTs - including NHS Direct, walk-in centres, minor injury units,urgent care and OOH centres - can cause confusion to patients, and thatit is vital patients are clear about where they can go for help aftertheir surgery closes.

Under the Alliance's proposals, practiceswould be directly accountable for OOH services that they commission -as in daylight hours - even if they did not provide the servicethemselves.

The report urges primary care to become moreintegrated - both internally as well as more aligned with hospitalservices - and that it retains the traditional focus on continuity ofcare.

Dr Dixon warned: "There's a danger that in trying tomodernise primary care we lose things that really matter, such aspersonal care and continuity".

"Patients need the personalrelationship and continuity of care offered by a trusted practitioner.They need someone who understands their history and socialcircumstances, and looks at the whole person rather than at a mere setof symptoms."

NHS Alliance