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Politics is driving this

The mass GP opt-out from out-of-hours responsibility may be damaging the quality of care of dying patients, an influential think-tank warns.

A report by the King's Fund concluded the new arrangements were 'a major concern', and were 'likely to reduce patients' continuity of care'.

Researchers audited palliative care during the period of transition before and after introduction of the new GMS contract last April.

It found provision of services was 'patchy' and communication between in-hours and out-of-hours services was often 'limited' and warn-ed the mass opt-out would exacerbate problems.

One GP co-operative was contacted by 81 patients with palliat- ive care needs during one month but had received just one handover form.

The report also suggested the opt-out was beginning to erode GPs' commitment to palliative care, with one in four GPs not seeing it as central to their role.

'This could reflect their perceptions of a less involved role for GPs in this area as a result of the new GP contract,' the report concluded.

Study leader Jenni Burt, a research fellow at the London School of Hygiene, said: 'I think the concerns we raised during our research show out-of-hours is something that comes up again and again. Palliative care patients might drop through the net.'

The study, which included a postal survey of 354 GPs across five PCTs in London, found heavy workloads, competing priorities and lack of peer support were affecting GP's communication with out-of-hours services.

It said GPs were prioritising specialist services and daytime district nurses when planning for the future, and out-of-hours was their lowest priority.

Dr Nick Brown, cancer lead at Kennet and North Wiltshire PCT and a GP in Chippenham, said the dearth of points in the quality framework was a 'major omission' and called for 50 points in the next draft.

'GPs are spending an awful lot of time in the bureaucratic process and trying to earn quality points and palliative care does not feature in that,' he added.

By Nerys Hairon

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