Out-of-Hours Service Endangering Patients, Say Doctors

PATIENTS’ lives are at risk because of a growing crisis in out- of-hours GP services, doctors are warning.

They say an underfunded new system has led to a dramatic drop in standards of coverage.

They report that: Vast catchment areas are leaving doctors travelling 80 miles to patients; Staff without the right medical knowledge are handling calls; Foreign doctors are being ‘parachuted’ in from abroad to cover shifts; Rural areas are particularly badly hit.

The GPs will sound the alarm in public at a major British Medical Association conference next week. Their unprecedented call will carry extra weight because, in most cases, they would not benefit personally from extra funding.

Under new contracts introduced last year, most family doctors opted out of doing evening and weekend work, accepting a pay cut of Pounds 6,000 for doing so.

Responsibility for out-of-hours services passed to NHS primary care trusts, which can provide them in-house or contract them out to private companies or notfor-profit co-operatives of GPs.

Doctors say many cashstrapped trusts are trying to cut costs on the service and the results could be disastrous.

They insist all evening and weekend calls must be handled by ‘experienced and appropriate health professionals’ and also call for extra funding for remote and rural areas.

Doctors from the Cornwall and Isles of Scilly region have tabled a motion warning: ‘The Government’s failure to fund the outofhours service adequately is putting patients’ lives at risk.’ Dr Andy Stewart, from Gunnislake, Cornwall, who drafted the motion, said: ‘We are concerned that underfunding from central government plus the financial difficulties of primary care trusts, will result in a service that isn’t as safe.’ Dr John Givans, secretary of the North Yorkshire and Bradford local medical committees, said: ‘I think it’s underfunded by something like 25 per cent.

Patients are getting a much inferior quality of service.

‘The number of doctors is being reduced and the areas they cover are being increased.

We have doctors having to cross 80 miles from one end of a patch to another.

‘We are getting locum doctors bussed in from God knows where.

One of my areas had a doctor flown in from Budapest to do outofhours sessions.

‘He was perfectly competent.

But there are often language problems and there’s certainly a problem of knowing the locality and the system.’ Dr Givans said there was now a shortage of experienced doctors willing to work in out-of-hours call centres. He said: ‘They are becoming very concerned that they are going to make decisions that are not in the best interests of the patients because of the pressure on them.’ The Bedfordshire and Hertfordshire committee will say patients are being ‘inappropriately’ referred to hospital or sent an ambulance, when in the past they would have been treated at home by their GP.

Chief executive Dr Peter Graves said: ‘Primary care trusts are proposing services through the night which do not include a doctor, but use nurse practitioners and clinicians’ assistants and so on.

‘This is a complete change from having a doctor available.’ Eric Peacock, chief executive of Northern Doctors Urgent Care, which covers 1.2million people in Northumberland and Tyneside, said: ‘The thing wasn’t properly thought through by the Department of Health. They completely underestimated the costs of running out-of-hours services.’ He said he was paid around Pounds 7.50 a year per patient but a realistic figure would be Pounds 10.

Dr Hamish Meldrum, chairman of the BMA GPs’ committee, said: ‘One of the reasons we have got to this stage is that for years GPs weren’t properly rewarded for the work they were doing.

‘Now people are seeing the real cost of providing this service.’ Tory health spokesman Andrew Lansley said the Government had allowed just 90 minutes of parliamentary time to debate the ‘fundamental’ change to doctors’ services.

‘That’s disgraceful,’ he said. ‘The Government had been getting out-of-hours services on the cheap for a very long time, thanks to GPs.

‘It was clear that there was a serious risk in transferring responsibility to PCTs in the way the Government did and now we are seeing the results.’ A Department of Health spokesman rejected the criticisms. ‘We do not believe patients are at risk,’ he said.

‘This Government made it clear in March 2004 that it is absolutely essential that whenever a patient needs to see a GP out of hours, they can do so. It has provided more than Pounds 300million this year to help fund local NHS provision of out-of- hours services.’

j.chapman@dailymail.co.uk