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Gold, incentives and meh

GPs will shun out-of-hours

Only one GP in five in some areas is willing to work out-of-hours shifts due to fears working conditions will nosedive when primary care organisations take over.

The warning came as PCOs said they will not be able to

afford out-of-hours services and were unable to plan for GPs to opt out next April because they have had no Government guidance.

Out-of-hours co-operatives said the troubles facing trusts had led GPs to pull back from shifts because of concerns they would face a backlog of cases and worries over safety during night working.

A survey by Macclesfield out-of-hours co-op in Cheshire found only five out of its 200 GP members were willing to work overnight shifts.

Dr Richard Usher, medical director of the co-op and a GP in Macclesfield, said working conditions were as important as pay in GPs' decision. 'That includes things like having drivers and feeling secure and safe doing night visits,' he added.

North Yorkshire Emergency Doctors (NYED) found one doctor in five in rural areas was willing to work shifts,

rising to 40 per cent in urban areas. Dr Jamie MacLeod, chair of NYED and a GP in York, said he was 'very worried' about the quality of service after GPs opted out.

'GPs were saying "Whatever you pay me, if the working conditions are poor, like always being five hours behind seeing patients, then I won't want to work",' he added.

The co-op was working with nine trusts to develop a service, but plans were 'only in gestation', he said.

PCOs will get £9,000 a GP to cover out-of-hours, but many have argued the figure falls well short of the cost of the service.

Dr Gareth Richards, professional executive committee chair of Central Suffolk PCT, said trusts could not afford out-of-hours cover unless they integrated GP services with ambulance and district nursing.

He said the trust would not be able to take over in April and was aiming to allow GPs to opt out in 'late summer' next year.

Chris Wright, chief executive of Devon Doctors on Call, said the average cost of its service was £12,500 per GP. He added: 'Clearly there is some work to be done in Devon on how we try to close that gap.'

Dr David Jenner, NHS

Alliance contract spokesman, said PCTs were making plans for out-of-hours but 'hadn't a clue how they will afford them'. He added: 'They will not have enough GPs to provide a home visiting service.'

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