By Gareth Iacobucci
Exclusive: GP out-of-hours care is being radically reshaped across England, with PCTs working with consortia to implement 'local doctor only' policies or merging services with the Government's new 111 urgent care number, a Pulse investigation reveals.
Trusts are enlisting the support of GP commissioners as they make sweeping changes to out-of-hours care in the wake of the Daniel Ubani case – with more than a third bringing in new rules stipulating that out-of-hours providers must be staffed by local GPs only.
The move is supported by some GP leaders, but has raised concerns among others that it could force up costs and leave some areas short of doctors to cover shifts – with the possibility local GPs will face growing pressure to step in.
New local-only policies follow the lead of NHS East of England, which stipulated that only GPs on local performers lists could work for out-of-hours providers following the death of Cambridgeshire patient David Gray at the hands of German locum Dr Ubani, who had been accepted onto a PCT performers list in Cornwall, but not locally.
The SHA hailed its policy as a 'template' for other areas, claiming it had led to greater patient satisfaction and improved cohesion of services.
Responses from 75 PCTs under the Freedom of Information Act reveal many trusts are following suit, with 28 now having restrictions in place, in London, the North-West, Yorkshire and the Humber, the Midlands and the South-East.
NHS Lewisham said that 'only Lambeth, Southwark and Lewisham GPs' were permitted to staff shifts. NHS Telford and Wrekin said: 'All GPs who work out of hours are on local or regional performers lists. No locum agencies are used.'
But many rural areas have not introduced similar policies, reflecting possible problems with costs and recruitment. NHS South Gloucestershire said it was 'satisfied our out-of-hours providers have robust procedures for selection and induction of new GPs'.
The investigation also found 71% of trusts have either re-negotiated or re-tendered out-of-hours contracts in the past year or plan to do so this year, with shadow consortia being handed key roles in determining how contracts are reshaped.
A quarter of trusts said they were combining out-of-hours services with the new 111 number, most radically in NHS South East Coast, where NHS Brighton and Hove plans to be part of a region-wide urgent care procurement from 2012/13.
GPC chair Dr Laurence Buckman warned introduction of 111 was placing strain on out-of-hours services: 'There are a lot of people who provide out-of-hours services who feel very keenly this is generating work. In areas where it is being piloted, 111 is creating more people who go to A&E although there's nothing wrong with them.'
Dr David Lloyd, joint medical director of Harmoni, which provides out-of-hours care to seven million patients, predicted restrictions on performers lists could lead to soaring costs if imposed across the board.
He said: 'In London there's a mobile workforce so pressure is less, but in Suffolk it's much harder to fill shifts and that's putting the costs up.'
But Nigel Wylie, chief executive of Urgent Care 24, said the benefits outweighed the difficulties: 'There's a quality advantage to using local GPs who know local systems of care.'
GPC negotiator Dr Peter Holden questioned the legality of PCT local-only policies: 'It's a restriction of trade and it's professionally idle of managers to say you must be on a local list. They should be writing to trusts where doctors are on lists to check.'Trusts insist on local GPs in out-of-hours overhaul