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At the heart of general practice since 1960

Don't lose interest in out-of-hours

From Dr Robert Morley

Birmingham

Of course GPs should still be involved in quality controlling out-of-hours care (News, June 22). We should be concerned about both quality and costs.

Many GPs now appear to be under the misapprehension that when they voted for the new contract they voted to opt out of out-of-hours care. They did nothing of the sort.

What they did was to vote for a contract which gave them the option of choosing to opt out. Believe it or not, some GPs actually chose to retain out-of-hours responsibility – in particular those of us fortunate enough to have an excellently run and led local GP co-op, to which we are happy to sub-contract care.

This was a far better option than running the risk of having it provided by the inevitably cheaper but far inferior service commissioned by the PCT.

Opted-in GPs are obviously concerned about this issue but the quality and cost of out-of-hours care should remain of vital interest to all of us, whether we opted in or out.

The vote at the LMCs conference, urging the GPC to steer clear of the issue, suggests LMC representatives completely missed the point.

I find it paradoxical that at a time when we are trying to get more influence over the quality and costs of secondary care through practice-based commissioning, we appear to be washing our hands of any interest in the delivery of primary care during nearly two-thirds of the week.

This will have inevitable consequences for our patients and our practices.

• From Dr Christine Haseler

Cheltenham

LMC representatives have sent a clear message that they no longer represent GPs providing out-of-hours care; they no longer have any concern about primary care for patients beyond the core, routine daytime illness and chronic disease management; and they no longer consider emergency primary care of core concern.

This gives the false impression that the profession as a whole has given up responsibility for out-of-hours primary care.

This reduces GPs, who will be seen to be doctors who are no longer skilled in acute medicine.

The clear message to the public will be that anything out-of-hours is beyond the remit of a skilled GP – additional expertise is required and GPs are not up to it. This may well become true.

However, there are thousands of GPs out there providing this extra skill in the highly professional manner in which they were trained. It is different work from day-to-day general practice.

We have been abandoned by our profession, LMCs and the GPC. There is an urgent need for a national association of out-of-hours GPs.

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