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Why out-of-hours care is such a disaster



The current state of out-of-hours care is entirely of New Labour’s making, says Jobbing Doctor

Policy in government is determined by the Lemming principle. Once an event occurs, government need to be seen to be doing something.

It doesn’t much matter what they do, so long as they appear to be taking action. The trouble is that policy follows issues around like lemmings chasing each other.

This week the flavour of the ‘lemming pack’ is all about the inadequacies of the GP out-of-hours service. This relates to a commercial organisation employing unsuitable people to do the job: in this case a German doctor who was flown in to deal with out-of-hours sessions in Cambridgeshire who had inadequate experience and poor language skills. A patient died because of his actions: we await the coroner’s verdict.

This is a crisis that has been threatening for years. It is entirely of the Government’s making. They should take full responsibility.

Jobbing Doctor has done out-of-hours work for 24 years. Our practice had a rota where we covered our patients all day, every day. We had to because we also needed to cover the local GP maternity unit. We did it because it was our professional responsibility to look after our patients. We did it because it was the right thing to do. It was certainly hard and grinding work (sometimes we could see up to 30 people a day on a Saturday, and another 30 on a Sunday in their homes).

But it was never valued or acknowledged. In an era when Government knows the cost of everything and the value of nothing, the authorities made a decision that their friends in the private sector could run the service cheaper and better. This was the first area of the great privatisation project that was mooted and not acted on by the Tories, and then – amazingly – embraced wholeheartedly (and foolishly) by New Labour.

In 2004 the Government valued the out-of-hours service given by GPs at £6000 per annum. That was all. So, inevitably, when they offered and increasingly frazzled group of professionals an opportunity to divest ourselves of this rather onerous part of our job for a relatively small sum, we jumped at it. Many of us were actually subsiding the local Doctor’s co-operative for this sum anyway, so it was a ‘no-brainer’.

The problem is that, at the heart of Government, nobody understands either professionalism or general practice. The advisers in Government were appointed because of their adherence to the New Labour project and not because they were the best people for the job. The Chief Medical Officer was notable by his silence, and the primary care ‘tsar’ was a little known Labour-supporting yes-man from leafy Cheshire. Still is, I believe, and he has also retired from clinical practice.

Then the service quickly deteriorated. people were having to wait up to eight hours for a doctor’s visit, or were travelling significant distances to an out-of-hours centre.

Over the last six years this has resulted in a doubling of the numbers of patients attending the Accident and Emergency department at evenings and weekends. The quality and experience of the clinical advice also deteriorated. It ended up costing at least three times as much as the old system.

So we have an inferior service, costing more, and resulting in high profile failures. There is an increasing bureaucracy to monitor the service (where prior to this it was professionally self-managed by the GPs), and the doctors have been thoroughly alienated by an arrogant and incompetent administration.

How very New Labour.

Jobbing Doctor