'Real nerves over out-of-hours'
Coventry PCT fears it will be held a 'hostage to fortune' over out-of-hours with some GPs demanding crippling rates of pay for providing cover.
The PCT already grappling with a near
£2 million prescribing overspend warned such demands could disable the service.
Peter Hodder, the PCT's director of primary care, said: 'There are two issues. The first is that patients mustn't see a difference between the current out-of-hours service and the new one. There is a real nervousness that they might.
'The other is that we need to secure the services of GPs.
'There is a real risk the PCT will be held hostage to fortune with some GPs saying we will only work if you pay us a high fee. This would disable the service.'
He said the PCT was offering GPs the chance to provide out-of-hours as a contract for service or as an employee of the PCT with benefits including annual holiday and superannuation.
Mr Hodder added PMS and GMS GPs would be treated 'equitably' in all areas of the contract to prevent different levels of service within Coventry.
Funding pressures have also caused the PCT to delay any decision on whether to commission enhanced services such as depression and drug and alcohol misuse care.
Dr Grant Ingrams, a member of Coventry LMC and a GP in the city, said GPs had lost confidence in implementation of the new contract because the PCT had tried to force through eleventh-hour changes. GPs were also confused over the mechanism for opting out of out-of-hours.
Dr Ingrams, a GPC member, went against GPC negotiator advice not to tamper with the contract
he insisted the PCT delete a clause giving it power to strike off patients who fall outside the practice boundary.
He said: 'It was only a minor issue but it was sneaked in between the draft and the final copy.
'Every practice has patients registered with it outside its boundary.
'If they were taken off they could miss vital health screening tests.'
Two-star PCT Coventry
Number of GPs/practices 170/63
GPs opting out of out-of-hours 100%
Average practice Q&O target 800-1,000 points
Prescribing overspend 2003/4? Yes £1.8 million
% of practices in PMS 50%
% of GMS practices needing MPIG 100%