Out-of-hours service in crisis

The out-of-hours service that allows patients to be seen by a GP when their local surgery is shut is in crisis, critics of the scheme have warned.

Last month the responsibility for providing out-of-hours care was passed from GP practices to Primary Care Trusts (PCTs) as part of the amended GP contract. However, since the switch occurred, critics claim that PCTs are cutting corners by failing to provide sufficient funding and enough doctors for the scheme.

Dr Mark Reynolds, chairman of the National Association of GP Co-operatives - the organisation that previously provided out-of-hours care by organising rotas for GPs - accused the PCTs of being “cost-focused, with quality off the agenda”.

Reynolds claimed that PCTs are underfunding existing GP co-operatives by approximately 10 per cent per year, with some PCTs spending between £5-15 per patient. A co-operative in North Yorkshire, he claimed, has already gone into administration because it was refused extra funding.

“PCTs are not usually funding out-of-hours services to the level required. Insufficient funds will lead to rushed, stressed and unsatisfactory consultations.

“There are a number of co-operatives which are suffering cash problems. Either they are going to have to cut back on the quality of services or they are going to fold,” he added.

Critics fear that if services are cut back patients will have no choice but to visit their local accident and emergency (A&E) department for treatment, placing an increased burden on an already overstretched hospital service.

Russell Hopkins, chair of Bro Morgannwg Trust in Wales, argued that this is already happening: “Many trusts are reporting 7 per cent, 10 per cent, 15 per cent increases in A&E patients and also increases in the numbers that have to be admitted,” he told BBC Radio Wales.

He added that patients felt that it was taking too long to get through to the new service and too long for a doctor to arrive.

However, Dr Michael Dixon, chairman of NHS Alliance, defended the scheme: “We warned at the start of this process that PCTs were on average £250,000 short to fund this service. We are bound to have teething problems but this is an issue we need to address.”

Peter Ganesh, vice chair of the Association of Primary Health Care Managers in Wales, agreed: “It is less than six months since the new contract came into place and we have got to sit down and review exactly what the arrangements are and where the bottlenecks are.”

He also argued that patients should be better educated in self-medication so that they do not need to contact a GP or attend an A&E department “for spurious reasons”.