Pulse’s recent front-page investigation highlighting low ratings by patients of care delivered by private out-of-hours providers in many parts of the country should come as no surprise.
Until 2004, nearly 27,000 GPs were members of not-for-profit GP co-operatives providing an excellent service to their patients. There was a network of more than 300 co-ops all over the country that provided care to nearly 30 million people.
It is worth recalling how GP co-ops evolved. Before 1977, most doctors had to be available to see their patients at any time of day or night, seven days a week. This was very stressful, so there were a few private firms providing an out-of-hours service in return for profits in some areas.
The standards of service were appalling, however, and most patients were seen by junior hospital doctors who had no previous experience in general practice. Not surprisingly, these patients had to be re-visited again by their own GP the following morning. It was an absolute shambles.
I wanted an alternative, and so turned to the idea of setting up a GP co-op. I called a meeting of local GPs in Bolton and shared my vision, explaining how the new service would relieve us of the need to be available 24 hours a day without being dependent on commercial providers driven by profit.
And so the first GP co-op in the UK was born in Bolton at midnight on 31 December 1976. On Call Ltd, the private provider, had to quit within a year as Bolton Medical Services became hugely successful.
Five years later, we set up the National Association of GP Co-operatives, which went on to become the biggest network of out-of-hours care providers in the NHS, eventually counting more than 300 co-ops as members.
But the 2004 GP contract changed everything. As GPs were relieved of the responsibility for out-of-hours care, many PCT managers invited private providers to step in rather than encouraging more co-ops to take over collective responsibility for out-of-hours care. These private providers cost the NHS a lot of money – and standards of care in some cases slipped to unacceptable levels.
There is no goodwill among GPs towards commercial organisations, and very few offer their services outside normal surgery hours. The way to improve out-of-hours care is to learn from the current debacle by inviting local GP communities to come up with a collaborative or co-operative model, which will be wholly owned and run by local GPs who know the area’s population well.
Patients will be reassured to know that while their own GP may not be available, they will be seen by another local GP. Those who work out-of-hours will be paid handsomely as an incentive for others to offer their services, but the overall costs will still be less than in a commercial venture and the standards of care will be higher. In a co-op, we should never need to rely on foreign locums to provide cover out of hours – we now know it puts lives at risk.
Our patients deserve nothing less than personal care from local GPs, and the Government must act to restore co-ops and prevent any further calamities.
Dr Krishna Korlipara is a GP in Bolton and founder of the first GP co-op in the UK