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CAMHS won't see you now

Out of hours is the next battle on the horizon

As reactions to pay freezes go, this one has been distinctly muted.

As reactions to pay freezes go, this one has been distinctly muted.

The news that most practices will get nothing again this year has been met more with bemusement and resignation than with outrage.

Partly, the Government chose such a convoluted way to announce the freeze that few GPs immediately grasped the implications.

A global sum rise sounds, after all, like a rise, even though the MPIG freeze means it actually won't be for nine in 10 practices.

But perhaps the main reason GPs haven't been taking to the airwaves in fury is that they are so used to bad news – a third successive pay freeze just seems par for the course.

But there is one potential bit of bad news lurking on the horizon that might see GPs snapping to attention.

Over the past four years, rumbles have grown over the opt-out from out-of-hours care – with concerns over soaring costs and slumping quality. Matters appear to be coming to a head.

Pulse this week reveals that out-of-hours providers are being forced to set strict thresholds for the proportion of cases seen by doctors or referred to hospital, in a desperate bid to claw back cash.

Our story came as the Tories and NHS Alliance both issued warnings on the quality of out-of-hours provision – and called loudly for GPs to take on commissioning responsibilities.

Expect the worst

The clouds are gathering and Lord Darzi's Next Stage Review could well be the storm.

The Government has already shown itself perfectly prepared to alter the GP contract unilaterally, even when, as with the pensions case, it has absolutely no legal right to do so.

Lord Darzi has already admitted he will be reviewing out-of-hours arrangements, and there's every chance he could be readying himself to thrust responsibility back to GPs.

The BMA must brace itself for another scrap – because this would be a move that really would provoke outrage.

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