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Two extremes on out-of-hours

It is staggering that Birmingham East and North PCT spends a mere £2.43 per patient, less than anywhere else in the UK, and more than £6 per patient less than the national average, on out-of-hours services (‘Crisis of confidence in out-of-hours care', News, 31 October).

One wonders what it does with the rest of the money it top-slices from the global sums of opted-out GPs. And this is a PCT that only needs to provide out-of-hours care for less than half of its population.

The reason is the majority of Birmingham GPs have chosen not to opt out of providing out-of-hours care, but instead retained responsibility for organising and providing it themselves for their patients.

They do this at a considerable personal financial loss as the cost of subscribing to their local GP out-of-hours co-operative is considerably in excess of the £6,000 drop in income incurred by opting out of responsibility.

The reason GPs choose to do this is quite simply that they prefer the standard of care provided by their own co-op (in which most members work shifts themselves) to the service commissioned on the cheap by their PCT. They are literally paying out of their own pockets to fund better care for their patients.

Furthermore, it is now the intention of the Birmingham and Solihull PCTs to divert out-of-hours development funding currently received by all providers – including the co-operative – and use it solely to pay for the out-of-hours care of patients who are the PCTs' responsibility. This will further increase the cost to GPs of subscribing to their co-op.

From Dr Robert Morley, Erdington, Birmingham

• From Dr Craig Barker, Plympton, Devon:

I feel it is time to speak up for the rare out-of-hours provider that provides a vastly superior service to the old system. Only four years ago I worked for a small co-operative, covering five surgeries and some 40,000 patients from 18.30 to 08.00, acting as call handler, receptionist, co-ordinator, driver, doctor and dispensing pharmacist.

Nights were spent driving round country lanes, trying to answer the phone, scribble down details on scraps of paper, often examining patients and answering the phone.

Devon Doctors is a not-for-profit organisation, covering the second largest county in the country, with diverse populations, such as the remote Dartmoor and Exmoor, the dense elderly population of Torquay, and the deprived inner-city patients of Plymouth. Despite this, shifts are very popular with local GPs with 80% of shifts filled by local principals, with virtually none available until the end of March.

Satisfaction questionnaires showed an impressive 83% of practices rating their services as good or excellent, and 50% of patients rating the service as excellent.

The system runs smoothly. Most treatment centres are manned 24 hours, shifts are not too long or onerous, and visits are not stressful – driven in comfort by a driver with GPS navigation, with a fully stocked formulary of drugs and resuscitation equipment in the boot.

It is clear out-of-hours can work if resourced, run properly and not paying a middle man trying to make a profit.

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