Dr Doug Naysmith

Labour Party | Bristol North West

GP Out-of-Hours Services

We don’t always get ill when it’s convenient and up to now it has been the responsibility of GPs to make sure we get treated in the middle of the night and at week-ends – even if they haven’t always come out to see us themselves.  During the last dozen or so years there has been a big swing away from the Dr Finlay model  of GP care and now only 5% of GPs go to see their own patients any hour of the day or night.  70% delegate the out-of-hours care of their patients to GP Co-operatives and 25% employ private contractors, but GPs still have the ultimate responsibility to ensure that we are looked after whenever we are taken ill.

This is due to change.  After December 31st, GPs will be able to opt out of providing out-of–hours care for their patients and it will be up to the local Primary Care Trusts (PCTs) to make sure that we still get the care we need.  Earlier this month, the House of Commons Health Select Committee, of which I am a member, published a report on “GP Out-of Hours Services” and we hope this will help to ensure the changes go through smoothly.  We took evidence from a wide range of individuals and organisations, including the National Association of GP Co-operatives (NAGPC).  Everyone who spoke to us thought the change could mean better services and that it offers the opportunity of the improved care for patients.  But there are some risks and we highlighted these so that problems can be anticipated and avoided.

We found that some PCTs are less prepared than others for the change over and need to do some work getting ready.  Many have already taken over their new responsibilities and others plan to do so before the end of the year, but it is worrying that others are still unprepared.  Also, despite extra money from the Government, many PCTs have not identified the funds they will need to pay for the out-of-hours cover.  GPs will still probably provide much of the out-of-hours care but they will be paid a proper rate for the job and it is not certain yet how many of them will choose to do this extra work.  The BMA estimates that 90% of GPs will opt out but the NAGPC believes that 70% of GPs who are currently providing out-of-hours cover through GP co-operatives will continue to do so – at least in the short term.  The long term future of GP co-operatives is less certain.

GP Co-operatives are, as Co-op News readers will know,  "not for profit" organisations owned, and mostly medically staffed, by local GPs who get together to share their out-of-hours care.  There are currently over 25000 GPs in more than 300 co-ops across the UK and there is a question mark over their future after the responsibility for out-of-hours care passes to the PCTs.    The Department of Health studied information from Strategic Health Authorities and concluded that half the provision of out-of-hours care will still come from GP co-operatives, but the NAGPC is not so sure. One of our witnesses argued that GPs are prepared to do out-of-hours work now as part of a co-operative because it ensures they will not have to be on call every night.  When they no longer have the ultimate responsibility for their own patients, they may be less willing to take their turn in the Co-operative rota.

In our report, we support the idea of involving a range of health professions including NHS Direct, paramedics, mental health professionals, nurse practitioners and social workers.  In some places this is already happening.  In Nottingham, for example, a GP co-operative worked with the local NHS walk-in Centre to develop nurses’ skills and they now have an integrated clinical team.  In Norfolk the six co-operatives amalgamated with the Ambulance NHS Trust to form a new service – Anglian Medical Care.  There is good practice around the country but not everywhere.  Our report points out that training people for their new role in providing out-of-hours care will take time and money.

Finally, one of our most important conclusions was that people must know where they can get help.  Currently there is some confusion with different services and different phone numbers to ring.  We stress that there must be clearer information setting out what local NHS services are available and how we can access them so that we can get the care we need.  The changes will bring the opportunity for a real improvement in patient care.  We must get it right.