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Gold, incentives and meh

Persistent cough

Dr Noel O'Kelly, a GPwSI in respiratory medicine in Spilsby, East Lincolnshire, passes on his top tips

Dr Noel O'Kelly, a GPwSI in respiratory medicine in Spilsby, East Lincolnshire, passes on his top tips

Underfunding and lack of manpower is running out-of-hours care into the ground ­ Rob Finch reports

Out-of-hours services across the UK are on the verge of


Underfunding by the Government and PCTs and cuts in the number of GPs working shifts because of a move towards nurse-led services is leading to a massive drop in the quality of care.

GP-led out-of-hours services are also struggling to survive because too few doctors are willing to work shifts for the pay rates on offer.

PCTs across the south-west of England this week reported a failure to hit targets for dealing with calls.

NorMed GP co-op in Northampton has asked local PCTs for a 20 per cent increase in its funding to end a 'manpower crisis'.

In Cardiff, out-of-hours company Healthcare Service 24 has come under fire after hiring cheaper staff-grade hospital doctors to cover shifts.

And in Scotland, the chair of NHS 24, Christine Lenihan, resigned this week in advance of a review of the triage service which is expected to be highly critical.

Earlier this year, GP co-op NYED in North Yorkshire went bust as a result of

PCT funding cuts. Other providers such as Kernowdoc in Cornwall have also reported problems.

GPs said the growing crisis showed how they had held services together before the new contract opt-out.

Dr Krishna Korlipara, who founded the first GP co-op in Bolton, said: 'The chickens are coming home to roost.' Services were deteriorating because PCTs were 'hiring locums on the cheap', he added.

Dr Laurence Buckman, GPC deputy chair, said: 'GPs provided the service on the cheap for many years at great personal cost. The service is now creaking very badly.'


Non-GPs cover shifts

GPs in Cardiff have accused the city's out-of-hours pro-vider of 'dumbing down' and threatening patient safety by hiring cheaper staff-grade hospital doctors to cover shifts.

Dr Haydn Mayo, a member of Bro Taf LMC, said: 'This is primary care. Ultimately they haven't got the right qualifications for the job.'

Healthcare 24 has denied the decision was an attempt at cost-cutting, arguing the doctors were not 'substandard' and had worked in A&E.

Dr Gareth Hayes, regional director, said: 'We're not talking about doctors on the cheap. We are not aiming to replicate primary care. I would not employ them as locums in the practice.'

But he admitted there had been problems with 'formal' supervision of the doctors.


Wages plea to PCT

GP co-operative NorMed has had to plead with Northampton PCT for a 20 per cent increase in funding to ease a 'manpower crisis'.

The move comes after the co-op appealed unsuccessfully to local GPs earlier this month asking them to cover dozens of unfilled shifts.

A survey by the co-op found the GPs had been put-off by a 23 per cent increase in shift workload.

Dr Darin Seiger, medical director of NorMed and a GP in Northampton, said the number of available GPs had dropped from 100 to 60 since it took over last August.

'We're in negotiation with the PCT to increase wages,' he said.

A spokeswoman for Nor-thampton PCT said that it was considering a short-term increase in funding to 'get them over the hump'.

South-west England

Targets being missed

PCT-run out-of-hours services across south-west England are missing Government targets and facing cash crises.

Swindon PCT said this week that fewer than two-thirds of emergencies were seen by a GP within an hour, compared with a target of 90 per cent.

A consortium of four PCTs in Somerset reported 72 per cent performance. Other trusts in Bristol and South Gloucestershire missed targets for assessing patients and GP visits.

Meanwhile, West Gloucestershire PCT's out-of-hours service has overspent by £233,000, 10 per cent of its budget. Cornwall co-op KernowDoc was asked last month to make £2 million of cuts.

Dr Tom Frewin, a GP in Bristol said GPs had been 'leaned on' by managers to opt out but were now being blamed.

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