Watson Esam | News | GPs' Surgeries Out of Hours Cover

Storm in a teacup?

A row which has been brewing for some time in relation to out-of-hours cover by doctors is set to continue to bubble.  Recent press reports of out-of-hours cover overnight being as low as one doctor for 650,000 people has caused a stir.

Out of hours cover

On 2 February the the BBC reported an acknowledgement by the Government that out-of-hours (OOH) cover, which is administered by the Primary Care Trusts (PCTs), was unacceptable in terms of variation of cover throughout the country.  This state of affairs had long been acknowledged by many GPs, although since most of them elected to contract out of OOH under their General Medical Services contract, the remit for provision of OOH has since 2004 been almost exclusively with the PCTs.  However, it appeared that the government's soul-searching - at least in response to a report in the Daily Telegraph the previous day - was limited to bemoaning the differences in levels of cover in geographical areas, rather than an acknowledgement of an overall failure of an effective policy for OOH in the country.

The Daily Telegraph had conducted its own investigation under which it had contacted 152 PCTs of which 82 responded.  The report's findings unsurprisingly disclosed wide disparities in coverage: Barnet and Enfield in North London had the headline-grabbing OOH provision of 1 doctor for 650,000 people.  If replicated throughout the UK this would mean that less than 100 doctors would be available during the night for a total population of around 60m.  Sheffield fared slightly better with two doctors covering a population of 530,000 - one for every 265,000 people.

Various factors have contributed to the latest flurry of headlines:

• initial observations by the Care Quality Commission 3 months into its investigation into Take Care Now which had retained a German doctor for OOH duties whose lethal injection killed a patient in February 2008



• the interim statement and progress report from the Care Quality Commission of its investigation based on a sample of 5 PCTs on the monitoring of OOH in October last year



• reports that Suffolk PCT had OOH cover for a population of 600,000 with 3 and sometimes just 2 GPs



• progress statement from the Primary Care Foundation on its progress in developing benchmarking for OOH



• anticipating the final report of the Care Quality Commission expected in early 2010

Inevitably perhaps, the blame game is developing.  The government can cover its tracks by pointing out that on 4 February, commenting on its own report "General Practice Out of Hours Service" it instructed the PCTs to review the way they oversee the provision of OOH to ensure that it is "robust and fit for purpose".

The British Medical Association added to the pressure on the PCTs the following day in an article putting the blame for an inadequate OOH service squarely at the door of the PCTs, who have been "more concerned with cutting costs rather than ensuring patients receive the best quality care."  It adds that the problem would be resolved if the PCTs were better monitored on their performance.  It would also like to see PCTs involving GPs more in the commissioning of OOH.

The Conservatives have pledged to reform OOH through renegotiating the GMS Contract - that is at least intellectually honest in acknowledging that if OOH is to be improved to a reasonable standard, then cash will have to be taken from elsewhere in the service - or rather from someone else, namely the GPs.

With the general election in the offing this leaves the cash-strapped PCTs with nowhere to go in terms of a quick solution to this issue, but a practical reason not to do anything too hasty right now until the political lines have been redrawn.

A shortened version of this article appeared in the Sheffield Telegraph on the 4th March 2010.

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