Reaction from GP leaders, politicians and stakeholders to the Government's report into out-of-hours care and the conclusion of the inquest into the death of David Gray.
GPC chair Dr Laurence Buckman
'The BMA agrees with this report when it says out-of-hours provision is unacceptably patchy. There are some out-of-hours organisations that provide a quality service and others, as has been highlighted by the tragic and avoidable death of David Gray, that fall shockingly short.'
'We think the recommendations made in this report are sensible and are glad to see the government has accepted them in full. We welcome the proposal for greater involvement of local GPs in assessing the quality of services. We hope this, combined with proposals to improve monitoring of services and the selection of clinicians, will raise the standard of out-of-hours across the board so that all patients, no matter where they live, receive high quality care.'
Conservative shadow health secretary Andrew Lansley
'This tragic case of Mr. David Gray, which happened in my own county, is an extreme example of the serious problems with out-of-hours care. In 2004, Labour took responsibility for out-of-hours care away from GPs. This was a serious error.'
'As a result we have patchy and often inadequate services, costs that have doubled and A&E attendances up by a fifth.'
'The review of out-of-hours care includes recommendations which we have pushed for, including adequate language checks. But we also need much wider reform. GPs should be put back in charge of out of hours services and should be collectively responsible for commissioning it. They are best placed to ensure patients get the care they need, when they need it.'
Liberal Democrat Shadow Health Secretary, Norman Lamb
'This is a shocking tragedy which has exposed fatal weaknesses in the out-of-hours care system. The scandal is that the Government has known about these weaknesses for some considerable time and has failed to act until today.
'I have put forward proposals – together with Stuart and Rory Gray, the two sons of David Gray – to ensure every doctor working in this country can speak English, is familiar with our health service and is well trained.'
Christine Braithwaite, head of investigation and enforcement at the CQC
'The death of David Gray was a tragedy. It should not have happened and such an incident must not happen again. The coroner has clearly highlighted what went wrong. Take Care Now, and the PCTs that commission its services, must learn the lessons.
'We are already looking at Take Care Now's current procedures as part of our review, as well as contractual and monitoring arrangements at the NHS trusts that buy its services. Any relevant information arising from the inquest will feed into our work, and we will of course take the coroner's views and final verdict into account. Our enquiries are nearing completion, and we will be reporting in full on the findings in due course.'
Cynthia Bower, Care Quality Commission chief executive
'It is absolutely critical that NHS trusts put monitoring of the safety of out-of-hours services higher up their agenda.
'Our work has suggested that the quality of monitoring has been variable.The wide-ranging recommendations in this report will help address these concerns. Commissioners and providers of out-of-hours services across the country must implement them swiftly for the benefit of local people.
'CQC's enquiries into out-of-hours provider Take Care Now are nearing completion. We will be reporting our full findings in due course and we will make further comments on this issue at that time.'
David Stout, director of the NHS Confederation's PCT Network
'While out of hours services have improved in recent years, the tragic death of David Gray has highlighted some weaknesses in how care is provided and commissioned.
'We support the recommendations for PCTs within Dr Colin-Thomé's report, including benchmarking and patient feedback tools, to help drive up the standards of out of hours care.
'The variability of how primary care trusts monitor out of hours GP services needs to be addressed and we agree with the proposal for more detailed national guidance to provide further clarity on which doctors can be admitted to and removed from the Performers List.
'PCTs, GPs and out of hours providers all have a responsibility to ensure patient care is never jeopardised. A return to the old system would not benefit patients or GPs, but it is right to examine the current system and consider the best way to bring about improvements.
Rick Stern, NHS Alliance's urgent care lead
'The death of David Gray was caused by an appalling error. Although this was a mistake made by one individual practitioner, it has highlighted wider failures which must be addressed. Therefore, it is essential that GP, PCTs and commissioners take recommendations in today's report on board to help drive up the quality of out of hours care.
'However, one must not lose sight of the fact that this is meant to be an integrated urgent care system, which includes NHS Direct, walk-in centres and extended GP surgery opening hours, not just out of hours care. It's also important to remember that, while safety is our top priority for out of hours services - and we are looking to work with national partners to put measures in place to make out of hours care safer – most out of hours services do a good job most of the time, something that seems to have been forgotten amidst the recent negative news reports.'
Niall Dickson, Chief Executive of the General Medical Council (GMC)
'This has been a terrible tragedy and an avoidable one. The sad case highlights serious failings in a system that should protect patients. One of those failings is that as the UK regulator we are not allowed to test the language and competence of doctors from the European Union as we do with doctors from other parts of the world.
'We have taken advice from leading Counsel and it is absolutely clear that in general, European applicants may not be required to undertake a language test. This is absolutely the case for doctors who hold European primary medical qualifications. The combination of EU law and domestic legislation (the Medical Act 1983) effectively excludes testing of a European applicant's language proficiency.
'The current situation is not acceptable. We are in continuing discussions with the Department of Health to resolve this situation.'
Dr Graeme Kelvin, chairman of Take Care Now
'We have offered our deepest sympathy to Mr Gray's sons and Ms Bubb for their loss and the distress they have suffered.'
'TCN has noted with interest the Coroner's factual conclusions on the events leading up to Mr Gray's death and, against a background of very wide interest in the employment of overseas doctors, we welcome the Coroner's recommendations for changes in the way that doctors from the EU would be able to register with PCTs.
'Although an expert witness told the coroner that TCN acted consistently with the practice of other providers at the time, this case has inevitably led us to examine very carefully what we do and how we do it. Several aspects of our service have already been improved, lessons have been learned and where it has been within our power, we have taken prompt action. We are justifiably confident in our ability to deliver good quality care when GP surgeries are closed.'