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Only local GPs should provide out-of-hours, say experts

By Gareth Iacobucci

Only GPs familiar with local health services should provide out-of-hours care, according to an analysis in the BMJ.

The analysis argues that the medical profession has a ‘duty to lead’ changes to the out-of-hours system to ‘systematically ensure quality and safety’, following the death of David Gray at the hands of German locum Dr Daniel Ubani.

The report came just days after health secretary Andrew Lansley said he expected many GPs to provide out-of-hours services themselves under the Government’s revamp of GP commissioning, raising fresh concerns that the shift in policy will push GPs closer towards a return to 24-7 responsibility.

Authors Dr Paul Cosford, director of public health for NHS East of England, and Dr Justyn Thomas, a clinical advisor to the same SHA, argue that only doctors with local experience should provide out-of-hours care, and that ‘the risky practice of bringing doctors from far afield to work short term shifts where they are unfamiliar with local health care should stop’.

They say: ‘Doctors familiar with local health care should provide out of hours services. This does not simply mean that GPs should be responsible for their own practice’s patients’ out of hours, since similar problems could arise through contracts with deputising services.

‘Instead it recognises that to ensure patient safety, out of hours care should be provided by doctors familiar with local health care, working in formalised teams, with assurance that the service has the characteristics of high quality care.

‘Many areas already operate such systems through cooperatives of local GPs, but crucially, it is not the case everywhere.’

Other changes recommended include a review of laws governing registration of doctors from the European Economic Area, and changes to the PCT performers list system, so that GPs must be on the list of the PCT where they work.

The paper advises that arrangements for out of hours primary care locally are reviewed across the board to ensure that doctors operate within structured teams providing high quality, safe care.

‘As a profession, we should not accept a system that allows incidents such as this in any part of the NHS. Clinical leaders throughout the NHS must advocate and lead the necessary changes.’

Only local GPs should provide out-of-hours, say experts