Editorial: GPs need out-of-hours responsibility choice

The GP role in out-of-hours services has always been a key issue for the profession. Indeed the abolition of 24-hour responsibility enshrined within 2004's new GMS contract played no small part in its successful backing by GPs.

Shortly after the coalition government came into power a year ago, health secretary Andrew Lansley said that making GPs responsible for commissioning out-of-hours care would result in many deciding to play an 'enhanced role' in providing the service.

GP reports this week that GPs could be expected to take back part of 24-hour responsibility by taking on work currently done by walk-in centres introduced by the previous Labour government in England.

On page 28, we analyse the out-of-hours landscape and, further forward, what the proposed changes will mean for the 90 per cent of the profession that has opted out of 24-hour responsibility and the remaining 10 per cent who continue in that role.

The push for local GPs to become more involved in providing and monitoring out-of-hours services should come as no great surprise. It was the conclusion of a government review in February 2010.

It was a logical move after Dr Daniel Ubani, who had been rejected for work by NHS Leeds because his English was so poor, was found to have unlawfully killed a patient in Cambridge during an out-of-hours shift.

Last year, LMCs narrowly backed GPs having a central role in commissioning out-of-hours despite fears that if GPs took on commissioning the services they could be forced to provide them as a last resort.

However, GPs should not accept commissioning responsibility if it is clear funding will be inadequate or be expected to provide out-of-hours as a 'last resort' if other arrangements fall through.

GPs wishing to resurrect co-operatives should be supported. However, more likely is consortia exerting pressure on GPs to pitch in if there are budget pressures. The ability for practices to continue to choose to refuse 24-hour responsibility is of paramount importance.

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