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What Brown must do about OOH

From Dr Krishna Korlipara, chief executive CMEDS, BoltonOpen letter to Gordon Brown MP

My colleagues and I are heartened to hear that NHS reorganisation will be your top priority if you become Prime Minister. I should like to mention recent developments that are seriously undermining the NHS and putting patients' lives at risk.

As a result of the 2004 GP contract, responsibility for out-of-hours care has been transferred from GPs to PCTs. There is no longer the incentive for GPs to provide out-of-hours care. Excellent care provided for nearly 30 years by a network of 300 GP co-operatives has been replaced with a fragmented service provided by PCTs that have had no previous experience or expertise in out-of-hours care.There is no engagement of local doctors in the delivery of out-of-hours care as PCTs commissioned these services to private entrepreneurs who are driven by profits rather than service commitment to the community.I am sad to see the adverse effects of these changes on patients.I refer you to an article published in Pulse (Opinion, 19 April) that explains recent changes fully and a way forward to involve GPs again. GPs could also be persuaded to work longer hours in the evenings and over the weekends to provide greater access to patients and provide personal care, if there could be some incentives. Sadly, the health secretary has not shown interest in listening to any suggestions for improvement. I am hoping you will find time to address this out-of-hours issue urgently before there is a crisis of public confidence.

• From Dr Kailash Chand, Ashton-under-Lyme, Staffordshire

The death of Penny Campbell, despite consulting eight doctors over Easter in 2005, is sad and deeply regretted. Ms Campbell was a victim of a change in the ethos of the Government's NHS policy.

GPs were rightly allowed to opt out of out-of-hours responsibility in 2004. Overworked GPs needed a better work-life balance but something important was lost from general practice when the change occurred – continuity of care. The Government's motive in allowing the opt out was to meet its bigger agenda of fragmenting GP services and bringing in private providers. But the motive for most new out-of-hours providers is to meet access targets and make profits for shareholders.The 'policy confusion' over whether an out-of-hours service is for urgent or unscheduled care also needs addressing.Relentless inappropriate demand has pushed the system to breaking point and the Government should stop encouraging patients to expect a 24-hour convenience service when there are insufficient doctors to provide it.The independent organisations that employ out-of-hours doctors and the PCTs that commission those providers need to learn from this tragedy to stop the same thing happening again.In addition, organisational and communication failures need rectifying if the next Prime Minister wishes to improve out-of-hours care.Gordon Brown is right to say the NHS needs to improve out-of-hours care for patients but to expect GPs to bail him out is unrealistic and unfair. No GP will return to the exploitation of being paid £6,000 a year to provide an out-of-hours service.

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