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CAMHS won't see you now

Over half of trusts cutting GP cover on out-of-hours shifts

PCTs are cutting the number

of GPs covering out-of-hours shifts by up to 50 per cent and replacing them with cheaper, less qualified nurses and emergency care practitioners, a Pulse investigation reveals.

GPs have warned that patient care is likely to suffer as a result and that the approach could prove more expensive in the long term by increasing hospital admissions.

More than half of the 50 PCTs surveyed by Pulse admitted they had cut the number of GPs covering out-of-hours since they took over responsibility for it in April 2004, or were planning to review their skill mix.

Last month a report by the Public Accounts Committee branded the PCT takeover of

out-of-hours in 2004 as 'shambolic'. GPs were allowed to opt out of responsibility for 6 per cent of the global sum, half what the service costs to provide.

Nineteen PCTs told Pulse they had already reduced out-of-hours GP numbers and 18 employed at least as many nurses or emergency care practitioners on shifts as GPs.

A further 10 PCTs have plans to review their skill mix and may also cut GP numbers.

Peterborough PCT has four nurses running an integrated out-of-hours and walk-in centre, and has replaced most GPs by emergency care practitioners – only one GP is on call overnight.

Northamptonshire and East Riding of Yorkshire PCTs have halved numbers of overnight GPs and recruited more nurse practitioners.

Dr Prasad Rao, a Stoke GP who manages an out-of-hours GP co-op in North Staffordshire, warned that the trend could bring more patients into surgeries the next day seeking reassurance and additional treatment from their GP.

'Nurses by nature are not risk-takers – they are risk-averse. I think GP workload could increase during normal hours.'

Dr David Lloyd, a London GP who helped set up the out-of-hours service Harmoni, one of the first to use nurse triage phone systems, said: 'There are some very well-trained paramedics and nurses, but you can't beat a GP for a diagnosis – the quicker and earlier the better.'

He added: 'Some PCTs believe that employing nurses is cheaper, but it can work out more expensive because GPs see more patients.

'A good GP would see four to six patients an hour, but you have to ask how many a nurse or emergency care practitioner would see. Uncomplicated problems with children could be dealt with by nurses, but GPs are needed for young babies or very old people.'

GP views of OOH cuts

West Hampshire PCT has reduced the number of GP visiting sessions from four to three.

Dr Stephen Linton, a GP in Farnborough, said: 'In terms of the overall costs, nurses work more slowly and admit more patients.

'If you run a service with emergency care practitioners they send far more people to A&E and under Payment by Results that's disastrous.'

Derbyshire PCT now has only three GPs doing the 'red-eye' shift, having brought in four nurse practitioners and emergency care practitioners.

Dr John Loveday, a GP in Chesterfield, said: 'Many nurses are not specially trained in handling medical emergencies.

'I think it probably will damage the quality of care.'

East Lancashire PCT is reviewing its skill mix although the new service will remain 90 per cent


Dr Malcolm Ridgway is a GP

in Blackburn and chief executive

of the GP-led company, which recently won the tender for

out-of-hours provision.

He said nurses tended to admit patients more often and that a nurse or paramedic-led system would send costs 'skyrocketing'.

But in Burnley and Pendle,

he said, they saw an average of only 1.5 patients per shift, which didn't justify spending £300-400 on a doctor.

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