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No substitution for a good GP

From Dr Ashish Dwivedi, chief executive officer, SELDOC

Your report 'Over half of trusts cutting GP cover on out-of-hours shifts' (News, 12 April) was comprehensive. Every action has positive and negatives attached. To increase allocative efficiency in OOH services, the organisations resort to cheaper options.

But there is a limit to substitution of doctors by nurses and that has to be considered. There could be 10 to 20 per cent of cases that can be dealt with by nurses (practitioners or higher grades) but the rest have to be dealt with by GPs.Beyond the reasonable percentage of substitution, it is difficult to see nurses performing a cost-effective role.At the end of the day we are all here for the patients and if we do not ensure patient satisfaction is achieved by trying to reduce the number of contacts to the minimum, the final effects remain suboptimal. At SELDOC we have only GPs doing triage. They are all local GPs registered with the PCT which increases accountability and leads to very good service delivery. We have been happy with the decision of retaining practices as opted in and are reaping the results now. So our services are provided by GPs and still we are one of the cheapest providers in the UK. We all need more empirical evidence to come to a conclusion, but intuitively I feel we might be overdoing the level of nurse–doctor substitution slightly.

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