GP involvement 'key to out-of-hours services'

Out-of-hours services in England work best where local GPs are involved in designing and running them, RCGP chairman Professor Steve Field has said.

Prof Field said out-of-hours services work best where GPs run them
Prof Field said out-of-hours services work best where GPs run them

The DoH last week accepted recommendations in a landmark review of out-of-hours services co-authored by Professor Field, which called for local GPs to help design and monitor out-of-hours services.

Health minister Mike O'Brien said he hoped the RCGP and LMCs could encourage more GPs to get involved, but said the DoH had no plans to hand back 24-hour responsibility to the profession.

'The way we see this system operating now is GPs advising how services are commissioned, what the requirements of the system are and also checking on the clinical qualifications of the people carrying it out,' he said.

GPC chairman Dr Laurence Buckman said the BMA backed the idea. The checks could involve 'out-of-hours experts' and LMC members, he said.

RCGP chairman Professor Field, who led the review with DoH clinical director of primary care Dr David Colin-Thome, said the only determinant of high quality out-of-hours provision was the involvement of local GPs. He called for every PCT to have at least one GP medical director.

The review followed the death of David Gray after he was treated by German locum Dr Daniel Ubani.

Professor Field and Dr Colin-Thome said out-of-hours care had improved since 2004 because there were now fewer overtired GPs struggling with 24-hour responsibility.

Mr O'Brien said he hoped reforms to strengthen out-of-hours services would be in place by the end of the year (see box). However, Conservative plans to hand over commissioning responsibility to GPs will interrupt such reforms if they are elected this summer.

Dr Paul Charlson, chairman of the Conservative Medical Society, said 'plenty of GPs' were 'interested in improving out-of-hours services'.

He warned that out-of-hours budgets were so tight, however, that allowing profit-making companies to provide out-of-hours care 'may not be wise'.

Professor Field said that although the review focused on England, all four UK countries should note its findings.

NHS chief executive David Nicholson has written to PCTs instructing them to act on the reforms 'urgently'.

The GMC, meanwhile, is campaigning for reform of the EU directive that prevents it from checking the language and competency of doctors who have qualified in an EU state.

GMC chief executive Niall Dickson described the situation as 'unacceptable'.

Out-of-hours reform

The DoH plans:

  • A national database of all GPs on performers lists to help identify problem doctors.
  • New national minimum standards for out-of-hours providers.
  • A model contract for PCTs procuring out-of-hours services.
  • Guidance to clarify how PCTs assess doctors' standard of English.


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