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Has out-of-hours really been thought through?

I agree with Dr Philip Rathbone whose letter was headlined 'Massive out-of-hours opt-out would threaten GPs' future' (February 24). The potential for GPs to opt out of out-of-hours care for some £6,000 may have deleterious effects on the NHS in general. different crisis.

I can't believe PCOs are going to be able to afford this, as it will take a lot of extra money. Therefore they are likely to try to persuade the out-of-hours providers to provide their services for less.

This will inevitably mean they will have to alter the skill mix of their teams to provide a cheaper service, but they still have to remain accredited and satisfy the conditions of the out-of-hours review while PCOs have to follow the recommendations of 'Reforming Emergency Care'.

In order to provide a cheaper service the pressure on the A&E department will surely increase and as a result the pressure on GPs who are trying to provide 48-hour access in-hours will increase.

To run a safe out-of-hours service requires an adequate workforce. To entice people to work out-of-hours you need financial incentives. What happens to quality if the workforce is not adequate, and what would the knock-on effects be?

Even if you do find enough people to work, the result will be a more costly, but less efficient, service.

I have not even considered

where the doctors to do home visiting are going to come from. Has this really been thought through?

Dr Michael Crow

Medical Manager Thamesdoc

GP Kingston upon Thames

Surrey

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