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Why GP out-of-hours provision will change beyond recognition

With acceptance of the new contract, the cat is out of the bag on out-of-hours. The pricing will lead to widespread opting out. PCOs have already started to consider how best they might provide such a service. Initially, they will look to commission a similar service to that already established as a way of providing continuity. But out-of-hours provision is set to change beyond recognition.

Many doctors who work for co-operatives do so because they feel responsibility for our 24-hour commitment. When responsibility for cover falls to the PCO the number of doctors available for out-of-hours work will inevitably decrease.

Most co-ops are run as non profit-making organisations, but what will be their relationships with their commissioning organisations? Co-ops will have to decide whether to set up as private companies or NHS bodies and will be required to deliver a contract for their commissioning PCOs.

A lot of issues arising out-of-hours are not best dealt with by doctors and it seems inevitable that other staff will be drafted in.

Skill mix and a shortage of doctors means PCOs will have to look at new ways of providing services. But it would be a false economy to trim the number of doctors working and replace them with nurses and paramedics without considering the wider consequences. PCOs should not lose sight of the fact that GPs are highly skilled at risk-management. While other staff may appear superficially cheaper, if their employment results in increased referrals it will be a false economy.

There needs to be an adequate service to ensure problems are resolved overnight. If out-of-hours staffing levels are lower we will see an overflow into daytime workload. The potential for patients to be 'sat on' in the small hours when their problems should be sorted needs to be recognised.

There is a temptation to say this is not our problem and walk away, leaving the PCOs to provide a service. If primary care does this we will not ensure our patients are properly cared for when the surgery is closed.

Dr Paul Cook

GP and director of North Derbyshire doctors

Chesterfield

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