Editorial: Out-of-hours care funding needs an overhaul

Out-of-hours care is a postcode lottery. As GP reveals today there is a huge variation in the amount of money that PCTs in England spend on their services.

This variation is deeply concerning and raises huge questions about quality of care.

Unsurprisingly, we found that PCTs that delivered out-of-hours care themselves spend the least, while those that use private providers spend the most.

There is real concern among GPs that in-house PCT services are too reliant on nurses, hence the low cost, while private providers do not represent value for money.

The NHS Alliance thinks that GPs should take back responsibility for 24-hour care and commission out-of-hours services using practice-based commissioning.

This argument is gathering support. At last year's LMCs conference, GPs backed a motion calling on the GPC to consider this, providing GPs had the necessary resources.

The vote was carried by a whisker, showing this is an issue that really divides the profession. But the motion did get to the nub of the problem - out-of-hours services need more resources.

GPs often get the blame for shoddy out-of-hours care in the national media because they gave up 24-hour responsibility with the new contract. But this oversimplifies things.

The reality is that the DoH grossly underestimated just how much out-of-hours care costs and failed to acknowledge the extra work that GPs put in before the new contract took effect.

Whether GPs take back responsibility for out of hours is an issue for the profession to debate, but if this happens adequate resources must be in place - the DoH cannot rely on GPs' goodwill as it has in the past.

Likewise, if PCTs remain responsible then the trusts must commit to appropriate funding. At the very least the DoH should consider some sort of guideline about how services are staffed and GPs should figure prominently within this.

The current spending variation is unacceptable and suggests many patients are not receiving the care they deserve.

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