MPs believe that the DoH underestimated the cost of out-of-hours by £70 million a year when it allowed GPs to opt out for £6,000 on average.
The transfer of 24-hour responsibility to PCTs was ‘shambolic’ because of underfunding and a failure to define the service trusts should provide, according to a report by the House of Commons Public Accounts Committee. It says that GPs are the only people to benefit from the change, a charge that GPC chairman Dr Hamish Meldrum has refuted, saying that the old system was unsustainable.
Less than half of PCTs are meeting targets for speed of access to advice or treatment, the report reveals and it says that the £6,000-per-GP opt-out fee was less than half the actual cost of providing out-of-hours services.
‘This sum was the outcome of a negotiation that was not rigorously conducted by the DoH, and which was based on a serious underestimate of PCTs’ likely costs,’ the report says.
It calls for the DoH to take a direct role in future contract negotiations rather than devolving negotiating responsibility to NHS Employers. The report also says the DoH should urge PCTs to incentivise practices to reinstate Saturday-morning surgeries where there is demand.
Committee chairman Edward Leigh MP said: ‘The DoH thoroughly mishandled the introduction of the new system of out-of-hours care.
‘It chose to act as an observer and no more in the negotiations with GP representatives. This hands-off approach to the costs of out-of-hours care was good news for the doctors but no one else. They were given a strong incentive to opt out and a disproportionate amount of taxpayers’ money is now having to be spent to provide the replacement out-of-hours service.’
GPC deputy chairman Dr Laurence Buckman said that there was ‘no question of GPs having hoodwinked anyone’.
He said the low price for the opt-out was agreed because a higher price would have meant a chronic undervaluation of in-hours work.
Meanwhile, the RCGP is to publish an audit tool that allows PCTs to monitor clinical outcomes out-of-hours.
The college is also calling for clearer information for patients about services on offer out of hours and wants the DoH to issue a new national strategy.