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At the heart of general practice since 1960

How out-of-hours care went wrong

From Dr Krishna Korlipara, founder and former chairman and president of the National Association of GP Co-operatives, Bolton

From Dr Krishna Korlipara, founder and former chairman and president of the National Association of GP Co-operatives, Bolton

The recent sharp deterioration of out-of-hours services can be very simply attributed to delegation of this responsibility to PCTs by this Government.

Most PCTs have no expertise in this area and as a result many have subcontracted these services to commercial providers rather than to GP-led collaboratives.

I am afraid there may be tragic consequences for some patients if the Government does not wake up to the reality and take radical action to remedy the situation.

Arguably the biggest success story of the past 30 years was the establishment of GP co-operatives, which were wholly owned and run by local GPs united in their commitment to provide excellent standards of care as much during out-of-hours as in-hours by having one among them working some nights while others took time off.

The result was that patients had better service from a local doctor who knew the area even if their own GP was not available. This system soon became preferable to relying on profit-driven commercial providers.

There were more than 270 GP co-ops, with nearly 25,000 GPs serving 30 million people. The new GP contract relieved GPs of out-of-hours work and gave it to PCTs. Consequently GPs lost the motivation to belong to a GP co-operative.

The only solution now is to invite GPs to organise themselves into local collaboratives in which they become the shareholders of the company and serve their local population. In return for creating high standards of care, they will be able to enjoy the success of the company they own.

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