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At the heart of general practice since 1960

GP out-of-hours bonanza

The ecstasy

GPs are cashing in on the new contract's lucrative out-of-hours market by earning up to £105 an hour for on-call shifts.

LMCs have warned that rates could spiral further with GPs beginning to demand as much as £150 an hour to work nights and weekends. Rates in some areas doubled on April 1.

GPs in around 40 PCTs ditched on-call responsibility at the start of the month, forcing trusts to increase rates to attract cover.

Dr Mark Denman-Johnson, from the Isle of Wight LMC, said pay rates doubled when the PCT took over, and now ranged from £60 to £105 an hour.

Tower Hamlets PCT is now tempting GPs to do on-call work by offering between £62 and £72 an hour. A spokesperson for the trust said the first year would cost £1.6 million, and it was expected to soar in years to come. 'We're not hugely cash rich but we are regarding it as an investment in primary care,' he said.

In Peterborough the PCT is luring GPs with pay from £70 to £100 an hour when they ditch responsibility later this year.

But as GPs took advantage of the rocketing out-of-hours rates, fears were growing that trusts would be unable to afford the massive bills.

Wessex LMC chair and New Forest GP Dr Nigel Watson said high costs were causing some PCTs to delay plans to take on out-of-hours.

Wessex PCT, which has already taken on the service, is offering GPs between £50 and £70 an hour. But he warned rates could spiral: 'Some GPs say they wouldn't work for less than £150 an hour.'

Dr Peter Hill, a GP in Brighstone, Isle of Wight, insisted it was 'not unreasonable' for GPs to charge higher rates.

'It's not cheap, but the PCT can't afford to lose the goodwill of the GPs,' he said.

'Realistically there is no alternative than to encourage GPs to stay on board. Of course I am entirely happy to get paid more money.'

Dr Dean Marshall, Lothian LMC secretary, said health boards in Scotland were stressed. 'Health boards say they can't afford out-of-hours. Unless the Scottish Executive provides more funding, other services will suffer.'

By Jacqueline Head

...But most wait to opt out

The agony

GPs in some areas suffered crushing disappointment last week when plans to allow them to ditch out-of-hours responsibilities fell through at the last minute.

In some places GP co-operatives were forced to pick up the pieces, but in other trusts GP practices were left to do their own on-call cover over the Easter holiday period.

In West Wiltshire PCT, GPs were promised an April 1 opt-out but a shortage of GPs to fill the rota meant the hand-over had to be delayed until July.

Dr Richard Edwards, professional executive committee chair and a GP in Westbury, said: 'Everybody is very disappointed and frustrated. The feedback has varied from disappointment to GPs being really quite angry.'

Dr Alan Greenwood, a GP in Warminster, Wiltshire, was outraged that his practice would have to do its own on-call cover over the Easter holidays and beyond. 'They know jolly well the co-op has been disbanded and we are still managing to get triage done but we have had to put in place our own emergency arrangements,' he told Pulse.

East Lincolnshire PCT pulled the plug at the last minute when a pilot plan descended into chaos because of a shortage of GPs.

GPs will now not be able to opt out until December, although the local co-op has stepped into the breach. Spald- ing singlehanded GP Dr Azmeena Nathu said: 'I think the general feeling is frustration, but at the end of the day there is nothing we can do.'

In Somerset GPs were also let down when the PCT announced it would not be able to make the transition until June at the earliest.

LMC chair Dr Harvey Sampson said: 'There are GPs that are disappointed and unhappy. If it had started in April it would have been wonderful.'

He added: 'This illustrates that out-of-hours services provided over the years has been taken for granted and to replace it is a very hard exercise.'

Other GPs expressed frustration at delays in setting up services. Dr Robert Ingles, Worcestershire LMC chair, said: 'There is frustration in Worcester and right across the profession. Major parts of the new contract are stalling.'

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