PCTs commission 'cheap and quick' out-of-hours services over quality

PCTs put 'access and cost' before quality when commissioning out-of-hours services, according to oral evidence presented to parliament's Health Select Committee.

Mr O'Brien: changes to legislation must be in place by the end of the year
Mr O'Brien: changes to legislation must be in place by the end of the year

Following the death of a patient at the hands of German locum Dr Daniel Ubani, the committee called upon senior health officials to explain what measures were being developed to prevent another tragedy.

GMC chief executive Niall Dixon said changes to the Medical Act 1983 should be made to ensure the GMC has the legal right to check the language skills of EU doctors wishing to work in the UK. The DoH is also looking at current legislation to ensure all doctors in the UK are covered by indemnity insurance.

RCGP chairman Professor Steve Field said the college was developing a three-month induction for EU doctors hoping to work in the UK with UK deaneries.

Paul Baker, chief executive of NHS Worcestershire, said the trust had already developed a ‘powerful, central body of GPs' that was performing unannounced visits on out of hours services and clinicians.

Dr Fay Wilson, chair of the BADGER out-of-hours co-operative and Mike Farrar, chief executive of NHS North-West, said PCTs had failed to assess the quality of out-of-hours providers.  

‘Because of the way the internal market works, we have taken reliability for granted and looked for cheap and quick services,' said Dr Wilson.

‘Performance management is about cost and how quickly patients are seen,' she said.

Mr Farrar said ‘PCTs still have some way to go' to ensure quality through out-of-hours providers' contracts.

Antek Lejk, director of commissioning and primary care at NHS Cornwall, was forced to admit the PCT did not even attempt to asses Dr Ubani's language skills, which led to the doctor being allowed to work in the UK after being rejected by another PCT.

‘We had no reason to think he wasn't competent,' said Mr Lejk.

‘You had no reason to think he was, either,' said Dr Howard Stoate, GP and Labour MP for Dartford, Kent.

Health minister Mike O'Brien said the PCT had 'breached the law' in failing to assess the language of doctors, and called for for trusts to adopt new safeguards, including a new model contract for out-of-hours providers, as soon as possible.

‘I want to sort this out by the end of this year,' said Mr O'Brien.

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