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Government considers giving out-of-hours care back to GPs

By Steve Nowottny

Ministers have revealed they are considering a radical revamp of out-of-hours care in the wake of a Pulse investigation finding GPs have lost faith in the current system.

The Department of Health is responding to spiralling concerns by discussing moves to hand practice-based commissioning groups across the country the power to run out-of-hours services.

The move came as a Pulse survey found only 38% of GPs felt PCTs were capable of running out-of-hours services, with serious concerns over the growing use of non-medical staff in place of doctors.

Almost half of nearly 600 GPs surveyed said out-of hours care had got worse since the 2004 opt-out, compared with just 19% who felt it had got better.

A separate survey of PCTs found almost half of all providers now used non-GPs for some face-to-face consultations, while nurses and emergency care practitioners conducted telephone contacts at 65% of providers.

A Department of Health spokesperson told Pulse: ‘GPC negotiators said GPs did not want to continue with responsibility because, among other things, of their long hours. But we are working with the NHS Alliance to explore how PBC consortiums might, in future, be able to widen their commissioning role, to include elements of the urgent care system.'

The move brings DH policy closer to that of the Conservatives, who have already said they would hand commissioning responsibility to GPs.

Pulse's investigation reveals the profession could be ready to take back responsibility for commissioning from PCTs. As many as 56% of grassroots GPs backed the proposals in principle – although only 31% would be willing to get involved with commissioning themselves.

GPC deputy chair Dr Richard Vautrey said he would support PBC groups playing a greater role in commissioning out-of-hours care, but that giving all GPs commissioning responsibility would be more complicated. ‘That's different – it would require legislative change.'

Support of GP commissioning – which follows a knife-edge vote in favour at the last LMCs conference – appears to stem from high rates of dissatisfaction with GPs' own local services.

Just 58% of GPs rated their local out-of-hours service as of high quality, and 57% said their patients had reported a bad experience with the service in the past year.

GPs appear increasingly sidelined as providers recruit nurses and healthcare professionals to cover shifts. Some 69% of respondents warned there were moves in their local area to cut the number of doctors on call.

In Oldham, nurses now handle 90% of telephone contacts, and nurse practitioners handle 10% of face-to-face consultations.

Dr Catti Moss, a GP in Guilsborough in Northamptonshire, said: ‘We have lost something by not having a GP. In our area, after midnight, you get through to a telephone operator who's working from a protocol.

‘They dish out far too many antibiotics and refer far too many people to hospital.'

Our investigation also found a nearly 20-fold disparity in PCT spending and complaints.

Out of hours care: Government considering putting GPs back in the driving seat Out of hours care: Government considering putting GPs back in the driving seat

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