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Only local GPs should work out-of-hours, say NHS managers

By Gareth Iacobucci

Moves to restrict the staffing of out-of-hours providers to local GPs have led to greater patient satisfaction and improved cohesion of services and should now be rolled out across the country, according to NHS managers.

NHS East of England said the blanket restriction, brought in following the high-profile Ubani case, could be used as a ‘template’ for other areas, after findings concluding that ‘local people prefer local doctors’.

The SHA issued the instruction last June as part of a tough new set of standards for commissioning out-of-hours services in the wake of the death of Cambridgeshire patient David Gray at the hands of German locum Dr Daniel Ubani, who had been on a PCT performers list in Cornwall, but not locally.

Since then, only GPs on the performers list of an east of England PCT or a neighbouring PCT have been permitted to work for out-of-hours providers.

A new report from the SHA concludes the policy has had a demonstrable impact on patient satisfaction and relationships between commissioners and providers.

The report says: ‘Whilst this instruction has presented a transitional challenge for some providers, all parties supported the principle behind it that PCTs require greater clinical oversight of the doctors they employ and those employed by providers, and that local people prefer local doctors.

It adds: ‘This principle was reinforced in the visits by the evident stability in the health systems that already employ high numbers of local doctors. We found greater public confidence in the services where there are high percentages of local doctors.’

Dr Ed Garrett, deputy director of GP commissioning at NHS East of England, said the visits had provided ‘positive evidence’ for rolling out the policy in other areas of the country.

He said: ‘For us this was a vindication. It’s not for us to advise us other areas, but it presents a template on how SHAs can run similarly across the country. We didn’t want our PCTs to be vicariously responsible for a GP on the performers’ list of a PCT in another part of the country.’

A spokesman for NHS London would not rule out implementing a similar system in the capital. He said: ‘NHS London has not issued any specific instructions to PCTs to allow only doctors on local performers’ lists to work for out of hours providers, but we are looking at the East of England report with interest.’

Dr Ethie Kong, a GP in Brent and joint-chair of Brent GP federation pathfinder said: ‘It’s a good idea from a clinical risk-management point of view because locally-accredited doctors know the area and the demographics.

‘The only question is, how practical is recruitment? It might be easier to implement in urban areas like where we are than in rural areas where the local medical workforce is smaller.’

Professor Helen Lester, a GP in Birmingham and professor of primary care at the University of Manchester, described the findings as ‘impressive’.

‘We know patients trust and preferentially book with their own GP in the surgery in the daytime so that sense of trust is only going to be multiplied when worried and unwell out-of-hours,’ she said.

Out of hours The East of England’s additional standards for out-of-hours

– OOH doctors employed by PCTs must be on the performers list of a PCT in the east of England, or that of a neighbouring PCT
– PCTs must deliver year-on-year improvements in patient experience of OOH services
– OOH providers should be able to show how they match staffing capacity to demand
– At least 1% of each individual’s handled calls should be reviewed
– A service should not have less than 5% of urgent cases on receipt
– All OOH staff must go through a thorough induction and appraisal process