Cookie policy notice

By continuing to use this site you agree to our cookies policy below:
Since 26 May 2011, the law now states that cookies on websites can ony be used with your specific consent. Cookies allow us to ensure that you enjoy the best browsing experience.

This site is intended for health professionals only

At the heart of general practice since 1960

We already say 'no' to poorly-paid out-of-hours - now we need to say no to 24/7 service

  • Print
  • Comments (9)
  • Save

The focus on this month’s forum for the Vale of York CCG was the NHS 111 launch and the commissioning of a new out of hours service, the procurement of which has been delayed for a year.

We are bracing ourselves for the introduction of 111, expecting that locally it will mean an increased workload in primary care as a result of call processing protocols sign-posting to us. We just have to pray that, in the long run, the service will gain confidence and backbone and become something trusted by the public at large and health providers alike.

At the same time, out-of-hours services struggle to fill shifts as increasing workload means that GPs can’t afford to take on the work (or don’t feel it’s well-paid enough).

So how do our fledgling newly-authorised commissioners go about procuring a new out-of-hours service to meet the needs of a mixed urban and rural population, whose demand seems to be rising year on year?

In theory, NHS 111 would result in patients arriving at the appropriate place for treatment. So it would make sense for the CCG to decommission minors from the A&E and use the income saved to fund an integrated out of hours service with multidisciplinary teams serving patients with genuine needs.

It remains to be seen if the CCG will have the courage to do something as bold as this, but without this step we’re likely to flounder on with a service that struggles to fill shifts as GP workloads get bigger and bigger, and the old-school doctors drift out of the NHS through disillusionment, or retire.

There’s another element that I believe needs to be stressed at this time, when people like Sir Bruce Keogh are shouting Tesco service values and seven-days-a-week convenience services from the rooftops.

We need the ability to say ‘no’ more. We all know that the vast majority of patient needs that are appropriate for primary care are not urgent needs and can wait to be seen in the cool light of day in a routine fashion. The profession must resist at all costs the pressure to run 24/7 services. What we do is not selling baked beans and dog food, and I pray that our new commissioners hold this uppermost in their minds as they design the out-of-hours services they wish to commission in the near future.

Dr Andy Field is a GP in York. He is also a member of North Yorkshire LMC but this article does not reflect the views of the LMC.

Readers' comments (9)

  • This sounds like you want to have your cake and eat it. Urgent care, by definition, arises round the clock. Either you continue to commission it from ED, who have always run a 24/7 service, or you commission it from primary care, in which case, they will have to work 24/7 (collectively, not individually of course).
    There is no other alternative. It will be good if NHS 111 convinces some patients who are not really urgent to wait to the morning, but the service must be there for those who really need it

    Unsuitable or offensive? Report this comment

  • Anonymous 3:45pm - 111 is NOT an advisory service it is a downgraded version of NHS direct and is simply there to direct people to what services to use. Most 'urgent' primary care 'stuff' is just NOT urgent.

    Unsuitable or offensive? Report this comment

  • My understanding from the benchmarking of the York out of hours service is that performs ok but it is expensive and I have seen the GP hourly rates which does bring into question and despite your comments, the value for money across the 2 out of hours services in North Yorkshire (the other being a commercial provider, Primecare, and even more expensive than yours as it will have shareholders to satisfy). In these times of economic blight how on earth can the commissioners justify halting a procurement of that size and continue to pay for an even longer term, a significantly higher price for out of hours than almost anywhere else?

    Unsuitable or offensive? Report this comment

  • Out of hours in North Yorkshire is expensive because it covers an area the size of Belgium, most of the PCCs cover areas of hundreds of square miles,rates of pay are unchanged since 2004, and staffing levels around 70% of the same date.
    We could have fewer Doctors, or fewer PCCs (though patients already travel up to 20 miles at times), and benchmark at lower costs, but we would then simply not perform to target, and more visits would need more staff.
    The procurement was suspended because the impact of NHS111 was uncertain, the Urgent Care Review is anticipated soon, and the 4 CCGs want further information and analysis as to whether they should commission jointly or independently, all of this meant it was impossible to define an accurate service specification, and the CCGs could have been liable for significant penalties if they had to change spec mid-contract.
    Rates of pay are significantly lower than daytime locum rates in North Yorks, hence the effect of market forces leading to local GPs declining to take up the work (DOI I am one of those that DO work in the system!).

    Unsuitable or offensive? Report this comment

  • Speaking as a user, I'm a huge supporter of the NHS but there is no doubt that out-of-hours service has become desperately unsatisfactory. Underspending and privatisation are the obvious culprits. The government seems to be trying to destroy the NHS so it can sell it off to its friends, The list of vested financial interests in both Houses of Parliament is deeply worrying. And, it must be said, the conflicts of interest of of GPs on some CCGs is almost as bad. Welcome to the USA.

    Unsuitable or offensive? Report this comment

  • A patient of mine in a Florida A+E recently for abd. pain - had scans etc - renal colic - bill for 5 hours - $ 12000. Welcome to private provision. We doctors wont be doing 80 hour weekends anymore - health and safety. Doctors will do well in the future. I was reading about £2.00 per consultation rates in NI. That will go.

    Unsuitable or offensive? Report this comment

  • Doctors are human too and patients at some point in their lives. The way things are going, they will have to join the patient's waiting lists soon.... to see THE GP !!! (a dwindling race)

    Unsuitable or offensive? Report this comment

  • When people refer to a change in OOH provision, they seem to refer to a mythical holy grail of OOH that has never existed and never will as part of the NHS. It is not possible to return to the days of GPs providing OOH work, then offering routine appointments during the day, as the demand for appointments is sky high. Take note of the recent Patient Association survey saying, at the same time, day time access must improve, and that GP surgeries must take back responsibility for OOH work. Meanwhile, there are decreasing numbers of GPs, and the threat of retirement of many more. The profession will struggle to attract candidates as pay is falling dramatically as workload and responsibility increases. At what point do we say that these myriad demands are unrealisable and unsustainable, without compromising on some elements. Will people want to sacrifice daytime appointments and perhaps routinely wait for several days/weeks, so that they can be offered an OOH service that is run by local GPs? Without enormous transfer of resources away from secondary to primary care, these demands are pie in the sky.

    Unsuitable or offensive? Report this comment

  • 111 is not a downgraded NHS direct as it can transfer 111 calls to 999 directly and vice versa. It can do what NHS direct used to do but has potential for being able to book appointments in services if allowed and can create a lot of data about patient needs/services used for commissioners.

    Unsuitable or offensive? Report this comment

Have your say

  • Print
  • Comments (9)
  • Save