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Crisis of confidence in out-of-hours care

By Steve Nowottny

The confidence of GPs and patients in out-of-hours care is plunging amid stark variation in delivery of services by PCTs, a Pulse special report reveals.

A detailed, two-month investigation has found evidence of serious shortfalls in out-of-hours care while patients are confused about how to access services and dissatisfied with their quality.

Almost two-thirds of GPs believe the standard of services has declined since PCTs took responsibility in 2004, and almost half have had patients complain about out-of-hours care within the last year.

Patients themselves are deeply concerned about safety, with almost half saying they have felt ‘less safe' since PCTs took over, while just one in 20 thought standards had improved.

One in five said they had received ‘poor' or ‘very poor' care the last time they sought help out of hours. Just 47% said their care had been ‘good' or ‘very good' – far below typical patient satisfaction scores.

Figures from PCTs show patients face a postcode lottery when it comes to expenditure on and standards of care.

Just one in five areas in England are 100% compliant with Department of Health national quality requirements – while a surge in private provision points to the determination of trusts to drive down costs.

Investment in services also varies hugely from one area to another, with some trusts spending up to seven times as much per patient as others.

Dr Peter Fellows, a GPC member and GP in Lydney, Gloucestershire, said: ‘PCTs could not organise the proverbial piss-up in a brewery, but it is Government under-funding, not PCT incompetence, that is the real villain. I actually fear for the safety of my own family.'

The Department of Health said a National Audit Office report last year showed patients' experiences of out-of-hours services were generally positive, while stressing PCTs had a legal responsibility to ensure good-quality care.

But GPs, patient groups and politicians expressed outrage and alarm over the investigation's findings.

Dr Richard Vautrey, GPC deputy chair, said the variation in out-of-hours standards was ‘unacceptable.' He said: ‘Since PCTs took over they have too often looked for the cheapest provider rather than the best quality.'

Patient Concern described the findings as a ‘scandalous indictment of primary care'.

Conservative shadow health secretary Andrew Lansley said the investigation showed responsibility for out-of-hours care should be handed back to GPs – even though 77% of GPs told Pulse they would not be willing to agree to this.

He said: ‘GPs must surely agree that they – as GP commissioners – would be far better placed collectively to commission OOH services.'

GPs continue to work on-call for OOH providers but fear quality of services has declined since the 2004 opt-out GPs continue to work on-call for OOH providers but fear quality of services has declined since the 2004 opt-out

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