The survey found that 2 per cent could not offer 'a GP consultation where clinically appropriate', but named seven that were unable to make that assurance.
Burntwood, Lichfield and Tamworth; Eastleigh and Test Valley South; Harrow; North Bradford; New Forest; Richmond and Twickenham; and Sutton and Merton PCTs were all unable to guarantee GP availability when surveyed by the NAO. The average PCT population is about 170,000.
During the change-over of responsibility for out-of-hours services from GPs to PCTs at the end of 2004 the prime minister Tony Blair was said to be anxious to keep GPs involved (GP, 29 October 2004).
Shortly afterwards, following plans by several PCTs to run a GP-free service, John Hutton, the then health minister, ordered every PCT to ensure that patients had access to a GP where necessary, a stipulation now in the DoH's 26 national quality requirements. However, some PCTs are not meeting this requirement.
The NAO report says that GP pay rates present one of the main difficulties, having been hugely underestimated by the DoH, leaving PCTs short of funds.
The DoH allowed GPs to opt-out of the work at a cost of £6,000, thinking that it would have to subsidise this by more than 50 per cent to £9,500 per GP to pay for the new service.
However, last year it increased allocations to £10,500 and the real cost to PCTs in 2005/6 was nearer £13,000 per opted-out GP.
An NAO spokesman said that the PCTs that were not able to guarantee a GP probably did have GPs working in the service but did not collect this kind of information and so could not definitively say either way.
A spokesman for Eastleigh and Test Valley South PCT said that the West Hampshire out-of-hours service, which covers the PCT, did employ GPs, while Harrow PCT subcontracts its service to Harmoni and thought GPs were available.
The DoH was unavailable for comment.
GPC chairman Dr Hamish Meldrum said: 'For years GPs have been subsidising out-of-hours care.'
- Out-of-hours progress, page 14
No promises PCTs that could not guarantee an out-of-hours GP visit:
- Burntwood, Lichfield and Tamworth
- Eastleigh and Test Valley Sth
- North Bradford
- New Forest
- Richmond and Twickenham
- Sutton and Merton