The use of overseas doctors in providing out-of-hours services - Health Committee Contents

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

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2010
Prepared 8 April 2010