2 The Reform of Out-of-Hours GP Services
in 2004
2. The reforms gave GPs the right either to continue
providing out-of-hours care services, or to opt out and pass the
responsibility to their Primary Care Trust (PCT). After the reforms,
the majority of practices (90%) transferred their out-of-hours
responsibility to their PCT.[2]
This was unsurprising. GPs had found the previous arrangements
onerous and a report by the National Audit Office (NAO) found
that, on average, each GP gave up a mere £6,000 per annum
when they opted out.[3]
3. Under the new system, apart from the small minority
of GPs who continue to provide out-of-hour services, PCTs commission
services either from commercial providers or from local not-for-profit
GP co-operatives. The cost to the NHS seems much greater than
before.[4] According to
the NAO:
Our survey found that the actual costs of providing
out-of-hours for 2005-06, the first full year of the new arrangements,
were £392 million, 22 per cent more than the £322 million
allocated by the Department and an average of £13,000 per
whole-time equivalent GP to provide.[5]
The Minister told us that GPs had "got the best
deal they ever had from that 2004 contract and since then we have,
in a sense, been recovering."[6]
4. The Department of Health showed little regard
to securing value for money for taxpayers when they negotiated
the out-of-hours GP service reforms in 2004. GPs gave up a mere
£6,000 per annum to rid themselves of their out-of-hours
obligations; the cost to the taxpayer in the first year of the
new system was an average of £13,000 per whole-time equivalent
GP.
5. Despite the increased cost of providing out-of-hours
services, and while the new system may be an improvement on the
old, there is considerable dissatisfaction with it. The British
Medical Association claimed that out-of-hours care was "unacceptably
patchy around the country" and that some services fell "shockingly
short" with respect to the quality of care.[7]
We were informed that patient surveys found that only two-thirds
of patients were satisfied with the services,[8]
but it is unclear whether this rating relates to access to services
rather than the quality of care received. The Minister acknowledged
that out-of-hours care was "not good enough" and must
be improved.[9]
6. While there are other problems with the new system,
in this inquiry we focus on the most prominent weakness, namely
commercial providers of out-of-hours services' employment of EEA
locums who have inadequate English and/or general practice expertise.
This has led to poor care and the deaths of patients. Mr David
Gray died in 2008 as a direct result of negligent care and gross
incompetence due to inadequate training and inexperience by Dr
Daniel Ubani, a German locum, on his first shift working for the
Cambridgeshire PCT.[10]
7. Following the inquest into Mr Gray's death, the
Cambridgeshire Coroner made recommendations for improving the
out-of-hours system. Reviews of out-of-hours services were carried
out by the Department of Health and the Care Quality Commission.
These highlighted shortcomings in regulation and the failure of
some out-of-hours companies and PCTs to vet EEA doctors, as they
are legally obliged to, and of SHAs to adequately monitor PCTs'
performance.
2 Ev 29 Back
3
National Audit Office, The Provision of Out-of-Hours Care in
England, HC (2005-06) 1041, Summary, para 3. Back
4
Ibid., Part Four. Back
5
Ibid., Summary, para 13. Back
6
Q 109 Back
7
Ev 50-51 Back
8
Q 2 Back
9
Q 107 Back
10
Inquest into the Deaths of David Gray and Iris Edwards: Coroner's
Summing Up, Decisions and Announcements Back
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