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The invisible man returns

Taking back responsibilty for out-of-hours is a poisoned chalice, says the Jobbing Doctor - and primary care tsar Dr David Colin-Thomé should know better than to champion it

The invisible man returns.

We, apparently, have a primary care ‘tsar' in the form of clinically-inactive Dr David Colin-Thomé. He has been a long and loyal supporter of New Labour and has been in post for a considerable time.

He has been in the thick of things through all the changes that New Labour have introduced, and now he is dancing to a different drum with the Conservatives, undoing some of the measures that he helped put in place.

Nice work if you can get it.

The hottest of hot potatoes is the out-of-hours service, which Dr Colin-Thomé was in post for when it was first taken off GPs. Now I never really understood the logic of that decision. At the time it was run efficiently, cheaply and effectively with the profession taking responsibility for it. For some reason, the Government wanted to take it off our hands, and I was pleased to be able to hand it over - I was getting too old and too tired to be doing a 16-hour day (8am till 6.30pm at the main job; 6.30pm till midnight at the out-of-hours centre), as well as overnight.

I believe that the underlying reason behind it was that the Government wanted to break the power of the profession; and who can forget when one of their ministers, Lord Ara Darzi, said as much when he stated that they wanted to ‘separate that fantastic bond' between patient and doctor. I can't forget that, or forgive it. Lord Darzi is a qualified surgeon. He should have known better.

We need to have someone who has credibility within the profession, who has skills in diplomacy and a track record of being an independent voice. I don't see any signs that the current incumbent is blessed with such skills.

So we are now in a situation when, suddenly, we are being expected to take back responsibility for commissioning these out-of-hours services. We will have exactly the same budget, but will be expected to take full responsibility for this: should another case occur when an imported locum mismanages a case, the Department of Health will turn round and say that it is the responsibility of the commissioning doctors.

The out-of-hours services are a very good example of why the latest Government ideas are dangerous: they privatised it believing that private was better. Now they want it managed by the self-same professionals that they have been undermining for years. Personally, I want nothing to do with commissioning these services. It is a poisoned chalice.

I would hope, at this point, that Dr Colin-Thomé would be telling his Government masters that this transition is going to be difficult to manage. He might like to point out that successive Governments have attempted to bully GPs into doing the latest fashionable thing - remember extended hours? This was Gordon Brown's attempt to appease the business sector by making surgeries open later to cater for those who are working? If you speak to the average GP they will tell you that they simply aren't doing that. I only get about 1 in 10 patients attending my late surgery who are at work.

Dr Colin-Thomé has decided to take the dictatorial approach and tell us to do the job, with no resources to fund it. This is a dangerous strategy. I object to a retired GP who is in the pocket of ministers doing this.

I think I preferred it when the primary care tsar was the invisible man.

He did less harm then.

The Jobbing Doctor is a general practitioner in a deprived urban area of England.

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