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GPs are warning of an impending crisis in out-of-hours care because PCOs are trying to run new services on the cheap.

Out-of-hours co-operatives say they are being underfunded by as much as 10 per cent and are demanding that the National Audit Office launch an inquiry.

At least one co-op, North Yorkshire Emergency Doctors, has already folded because of a funding crisis.

Dr Mark Reynolds, chair of the National Association of GP Co-operatives (NAGPC), said services were being threatened by PCOs' 'misplaced priorities'.

He added that clinical governance directors were under immense pressure to compromise on the quality of services.

'Many PCTs are cost focused, with quality almost off the agenda,' Dr Reynolds said.

'Insufficient funds will lead to rushed, stressed and unsatisfactory consultations. The inevitable consequence will be overflow into A&E. This is a much more expensive and less satisfactory solution.'

He added that the NAGPC had asked the Government to link out-of-hours commissioning and funding with PCT performance ratings.

Dr Mike Dixon, NHS Alliance chair, said PCOs were 'the fall guys' and the real problem was lack of Government investment and spiralling co-op costs.

He said: 'The costs are short by around £200,000 per PCO and they have to find that from their baselines.'

Dr Dixon added that quality had not suffered and that PCOs needed to question co-ops' payments to check that GPs weren't paid too much. 'We need some norms of what reasonable costs are,' he said.

Dr David Carson, a former GP and Government adviser on out-of-hours, also criticised co-ops for failing to implement cost-cutting measures such as skill mix.

Dr Carson, who wrote the Government's out-of-hours review, said enough cash had been poured into the system even allowing for the increased cost of staff.

'The solution is to ensure the best use of all staff including doctors,' he said.

By Rob Finch

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