2 The Reform of Out-of-Hours GP Services
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.
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. 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. According to
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.
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."
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
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.
We were informed that patient surveys found that only two-thirds
of patients were satisfied with the services,
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
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
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'
2 Ev 29 Back
National Audit Office, The Provision of Out-of-Hours Care in
England, HC (2005-06) 1041, Summary, para 3. Back
Ibid., Part Four. Back
Ibid., Summary, para 13. Back
Q 109 Back
Ev 50-51 Back
Q 2 Back
Q 107 Back
Inquest into the Deaths of David Gray and Iris Edwards: Coroner's
Summing Up, Decisions and Announcements Back