Chris Lancelot: Sense must prevail in out-of-hours care

One of the problems of New Labour has been its addiction to short-term populist solutions at the expense of long-term strategy.

When it attempted to improve access to healthcare its initial solution was to create several 'cool', overlapping and high-profile solutions. With much razzmatazz it set up NHS Direct and drop-in centres, introduced a four-hour waiting target for A&E and encouraged GPs to give up their out-of-hours responsibility, hoping that PCTs would step in and deliver out-of-hours care more efficiently.

And that's when it all went wrong. Not only did out-of-hours primary care become fragmented, less efficient and more expensive, but patients became confused over which service to contact, and how to do it. A recent survey from the Healthcare Commission now suggests that this uncertainty has contributed to the 20 per cent rise in A&E and Urgent Care Centre attendances over the past four years.

Why am I not surprised? The first rule of progress is 'If it ain't broke, don't fix it.' Certainly, never replace anything that works tolerably well with a high-profile, untested solution. The Healthcare Commission is correct: how does a patient know which service to call upon?

The whole out-of-hours system is too complex. It needs reconfiguring using simplicity, reliability and long-term sustainability as its watchwords. The government is forever caterwauling about the importance of extended access to healthcare: let it demonstrate how to do it properly through its own mechanisms and services.

The simplest method would be for a single national organisation to respond to all out-of-hours healthcare needs. It would need a single, national and well-publicised telephone number for urgent out-of-hours health problems. Calls should be triaged promptly by giving advice, or routing patients to locally commissioned out-of-hours services, A&E or by calling the ambulance service.

A system like this is hardly rocket science, but is compact, simple and integrated - and probably the safest and most cost-effective way of dealing with out-of-hours problems.

In trying to appear 'cool' the government produced a less workable, more confusing and less effective solution. It is time to remove the hype and let sense prevail.

Dr Lancelot is a GP from Lancashire. Email him at

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