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The waiting game

Chaos looms on out-of-hours opt-out

GPs are struggling to make decisions on whether to drop their out-of-hours responsibility because of uncertainty over potentially huge variations in the cost.

A briefing document from the NHS Confederation said GPs should tell their primary care organisation by the end of September whether they want to give up out-of-hours work.

But GPs are complaining they need figures from the GPC setting out the price of opting-out.

GP negotiators insist the cost will be 6 per cent of the global sum for both Carr-Hill and MPIG practices, and will still average £6,000 per GP principal.

But the 11th-hour decision to base global sums on registered lists, together with confusion over MPIG payments, has left many practices unable to make more than a rough estimate of their global sum.

Dr Fay Wilson, GPC member and medical director of Birmingham and District GP Emergency Rooms, said there would be 'substantial variations' in the opting-out cost and GPs could not be expected to make a decision by the autumn.

'Doctors have widely varying list sizes ­ some have tiny lists and others very big. The doctors with huge lists will pay more for opting out,' she said.

Dr Tony MacDonnell, chair of Dartford and Gravesham Doctors on Call, said: 'The truth is this financial information has not been given to GPs. PCTs have not even said how much they would pay practices to cover their Saturday mornings.'

Dr Donald Brown, a board member of Moray Doctors on Call and a GP in Elgin, said most GPs in the small co-op wanted to opt out but that could change if they got 'disastrous' financial figures. 'We know so little about the

contract and funding flows and what is going to happen to us.'

Dr Mark Reynolds, chair of the National Association of GP Co-operatives, said: 'It's unfortunate how unclear it is. People will be confused right up until the last minute and possibly beyond.'

 · No new ready-reckoner

until next year, page 14

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Dr David Lloyd has advised GPs unsure about the cost of out-of-hours to opt in for the time being and retain some control over the service.

Dr Lloyd, external relations director of west London co-op Harmoni and a GP in Harrow, Middlesex, said : 'The way the opt-out is phrased it's jolly difficult to opt in later, so it's an easier decision to keep responsibility at this stage. It's a very tight timetable and there is not enough information for the ordinary GP to make a decision this year.'

Dr Lloyd said opting in did not necessarily mean working shifts, as GPs could negotiate with co-ops to provide services if they did not want to work.

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