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At the heart of general practice since 1960

A fragmented picture on out-of-hours

For GPs, the 2004 out-of-hours opt-out was a landmark moment, not only providing an escape route from spirit-sapping night and weekend work, but also fundamentally recasting the role of the doctor.

For GPs, the 2004 out-of-hours opt-out was a landmark moment, not only providing an escape route from spirit-sapping night and weekend work, but also fundamentally recasting the role of the doctor.

No longer were GPs legally responsible for patient care at any time of day or night, allowing them to put a proper value on their working hours for the first time.

But if the opt-out was a grand moment for general practice, it was a grand experiment for the Government.

The care of millions of patients for more than two-thirds of the whole week - if you work it out by hour - was transferred in a stroke from one system that broadly speaking worked to another that was entirely new and unknown.

But this grand experiment had a fatal flaw.

It was set up so carelessly - or, perhaps, so deviously - that it is impossible to say whether it has worked or not.

None of the information now used to assess performance - measured by the new quality requirements or the patient complaints held by PCTs - was collected in a comparable form in the run-up to the opt-out.

Nor was patient satisfaction assessed before and after 2004.

Nobody - not GPs, politicians, healthcare managers, nor least of all patients - can say for certain whether this expensive reconfiguration has been a qualified success or a horrible failure.

Wildly varied data

What is possible, as Pulse has done this week, is to analyse PCT data and track evolution of out-of-hours since the opt-out.

And what a muddled and fragmented picture that paints.

PCTs, as they rush to consolidate provider contracts, are opting for a wide variety of models of care - some signing up their own provider arms, others private companies, social enterprises or GP co-operatives.

And both funding and patient complaints vary to an astonishing degree between trusts, by as much as 20 times.

Such differences seem barely credible, and it is possible PCTs are simply unable to get their own figures right.

But this lack of trustworthy information itself poses a serious problem, since it is impossible to improve commissioning if you can't work out which models of care are working and which are not.

At the moment, that's a problem for PCTs but it may not be long before commissioning is landed at GPs' door.

editorial

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