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We already say ‘no’ to poorly-paid out-of-hours – now we need to say no to 24/7 service

The focus on this month’s forum for the Vale of York CCG was the NHS 111 launch and the commissioning of a new out of hours service, the procurement of which has been delayed for a year.

We are bracing ourselves for the introduction of 111, expecting that locally it will mean an increased workload in primary care as a result of call processing protocols sign-posting to us. We just have to pray that, in the long run, the service will gain confidence and backbone and become something trusted by the public at large and health providers alike.

At the same time, out-of-hours services struggle to fill shifts as increasing workload means that GPs can’t afford to take on the work (or don’t feel it’s well-paid enough).

So how do our fledgling newly-authorised commissioners go about procuring a new out-of-hours service to meet the needs of a mixed urban and rural population, whose demand seems to be rising year on year?

In theory, NHS 111 would result in patients arriving at the appropriate place for treatment. So it would make sense for the CCG to decommission minors from the A&E and use the income saved to fund an integrated out of hours service with multidisciplinary teams serving patients with genuine needs.

It remains to be seen if the CCG will have the courage to do something as bold as this, but without this step we’re likely to flounder on with a service that struggles to fill shifts as GP workloads get bigger and bigger, and the old-school doctors drift out of the NHS through disillusionment, or retire.

There’s another element that I believe needs to be stressed at this time, when people like Sir Bruce Keogh are shouting Tesco service values and seven-days-a-week convenience services from the rooftops.

We need the ability to say ‘no’ more. We all know that the vast majority of patient needs that are appropriate for primary care are not urgent needs and can wait to be seen in the cool light of day in a routine fashion. The profession must resist at all costs the pressure to run 24/7 services. What we do is not selling baked beans and dog food, and I pray that our new commissioners hold this uppermost in their minds as they design the out-of-hours services they wish to commission in the near future.

Dr Andy Field is a GP in York. He is also a member of North Yorkshire LMC but this article does not reflect the views of the LMC.