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PCOs are struggling to fill shifts in time for the handover and the Government is under fire for stoking unrealistic expectations ­ By Joe Lepper and Ian Cameron

Fears are mounting that the out-of-hours opt-out in the new contract has 'gone worryingly wrong'.

Last week it emerged that in a number of areas where PCOs are planning to take over the service on October 1, out-of-hours providers are still battling to fill hundreds of shifts.

Concerns have been raised elsewhere that PCOs due to take over in December are also ill-prepared.

And in at least two areas, Cornwall and Somerset, threats have even been made that the planned October 1 handover could be postponed until the end of the year unless GPs commit to filling hundreds of shifts.

The urgency of the issue prompted Liberal Democrat MP Alan Beith to ask Health Secretary John Reid in the Commons earlier this month: 'Has this part of the new contract not gone rather worryingly wrong?'

Mr Reid denied this, insisting that the handover to PCTs would mean patients had 'access to high-quality, appropriate and timely health care out of hours'.

He also issued a guarantee that patients would have access to GP home visits and Saturday morning surgery.

But this pledge has infuriated the NHS Confederation, which warned in a strongly worded statement that PCOs would find it difficult to comply with the Health Secretary's demands, given the new contract would force them to focus on skill mix.

The confederation's director of policy, Nigel Edwards, said: 'Specifying that PCTs should provide Saturday mor-ning surgery is a degree of detail too far ­ this type of guidance should be unnecessary and could be unhelpful.

'This will add to the cost of many out-of-hours services which are already putting significant financial pressure on PCTs, without necessarily improving the quality of the service. Even PCTs that can afford to hire a GP to be on call may struggle to find doctors willing to work these shifts.'

Already one PCT, Lincolnshire South West, has launched a GP-less service for its red-eye shift, and others could follow.

It is not just the NHS Confederation that has predicted waning GP involvement in out-of-hours care.

According to Cumbria LMC chair Dr Colin Patterson, the number of GPs volunteering for shifts could be cut by half next year, when GPs begin to feel the benefits of the new contract's pay rise.

'The economic reason for volunteering I think will be reduced dramatically,' he says.

GPs have already made clear they would refuse to work for low pay rates when they can earn more as locums.

Of PCOs contacted by Pulse the lowest weekday evening hourly rate is £50, offered by West Hull PCT, Blackwater Valley and Hart PCT and Devon's trusts.

For the red-eye shift, some trusts, such as Bromley PCT, are offering just £60 an hour, while Brighton and Hove City PCT is offering £100 an hour and GPs in North Staffordshire can earn £110 an hour.

In Scotland problems have arisen in rural areas, with more than 30 rural GPs writing to health minister Malcolm Chisholm to express their concerns over the lack of GP involvement in plans for on-call.

They fear too much responsibility is being placed on the Scottish Ambulance Service, which they say needs more ambulances to cope.

Dr Susan Bowie, a GP in Manse, Shetland, said: 'The other night I waited two-and-a-half hours for an ambulance. What would have happened if a GP hadn't been available?'

GPs also worry that NHS 24, Scotland's nurse-led help-line, will be unable to cope when it has responsibility for out-of-hours calls.

Another problem apparently caused by the out-of-hours opt-out is increased pressure on A&E units.

Visits to Norfolk and Norwich University Hospitals Trust rose by 4 per cent between June and August. GPs transferred responsibility in July, when East Anglian Ambulance Trust took over. A spokeswoman said she believed out-of-hours changes were a factor.

But the chair of the NHS Confederation's contract negotiating team, Chris Town, dismisses talk of a meltdown as 'scare-mongering'. 'When you develop a new system people expect it will be robust ­ all-singing all-dancing. But that is unrealistic. This is a transition period.'

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