Memorandum by the British Medical Association
(OHS 04)
THE USE
OF OVERSEAS
DOCTORS IN
PROVIDING OUT-OF-HOURS
SERVICES
In response to the Committee's announcement
of an evidence session on the use of overseas doctors in providing
out-of-hours services (OOHs), I thought that I would use the opportunity
to write to you in advance of the session as the General Practitioners
Committee of the BMA has also been in close discussion on this
issue for almost a year with Government and a number of the other
stakeholders that will appear as witnesses for the evidence session.
I welcome the Committee's interest in this important matter, as
it is timely following both the findings from the David Gray inquest
concerning the activities of Dr Daniel Ubani and the Department
of Health's own review of OOHs.
Understandably, this is a complex subject area
covering fitness to practice and language competency for overseas
doctors undertaking OOHs work and the broader issues surrounding
OOHs provision. What is clear is that OOHs provision is unacceptably
patchy around the country and while there are some OOHs organisations
that provide a high-quality service there are others, as has been
highlighted by the tragic and avoidable death of David Gray, that
fall shockingly short. We believe that the recommendations made
in the report to the Department of Health are sensible and we
are pleased that the Government has accepted them in full. In
particular, we welcome the report's proposal for greater involvement
of local GPs in assessing the quality of services. We hope that
this, combined with proposals to improve monitoring of services
and the selection of clinicians, will raise the standard of OOHs
across the board so that all patients, no matter where they live,
receive high-quality care.
In terms of the use of overseas doctors in providing
OOHs services, we strongly encourage OOH providers and primary
care organisations (PCOs) to be much more careful to ensure that
anyone coming from abroad to work in the UK as a GP has relevant
clinical training and experience, appropriate for the breadth
of UK GP activity, and sufficient English language skills. It
is possible that some doctors who have undertaken their training
outside of the UK may not offer the range of experience that UK
trainees possess and may not be able, in our view, to provide
the same quality of service to NHS patients. The BMA is more than
willing to help with plans to establish a national database of
overseas doctors working as GPs. The Government has already asked
the BMA to help in this regard and we have agreed to do so.
With regard to other solutions to improve OOHs
services, some commentators have suggested that GPs should return
to pre-2004 arrangements where GPs were personally responsible
for making the arrangements to deliver OOHs and in the event of
not being able to make suitable arrangements, were forced to offer
this service personally. With the current pace of general practice
and level of demand for OOHs, making the GP liable to being the
provider of last resort is unsustainable, dangerous for patients
and would return general practice to a time when it struggled
with recruitment and retention of doctors. Nonetheless, significant
changes must be made to address the current widespread variation
in the quality of OOHs provision and the BMA is fully behind such
moves.
There is considerable variation in the funding
of OOHs services by PCOs. Research by the Primary Care Foundation[41]
has indicated that PCO funding ranges from as little as £3
per head to nearly £16 per head, underlining the view that
many PCOs have been more concerned with cutting costs rather than
ensuring patients receive the best quality care. Proper investment
by PCOs will enable the provision of quality services and would
also lead to better local recruitment and retention of medical
staff.
Standards of OOHs care could also be improved
if PCOs were required to involve local GPs in the commissioning
of OOHs care so that high-quality, timely and cost-effective services
can be developed that are sensitive to local circumstances. GPs
must be involved in the commissioning process at a level that
does not force them to be providers of last resort, but permits
them to raise objections to any PCO plans that offer unacceptably
low standards and to have their concerns listened to and acted
upon.
Added to this, the application of appropriate
monitoring of PCOs will ensure that quality standards are maintained
and OOHs services are improved. Clear minimum standards for OOH
providers and the GPs they employ are absolutely necessary. Every
PCO should have to gain approval for its OOH plans from local
commissioning groups and the Local Medical Committee (LMC). Before1996,
it was mandatory for the old commercial deputising services to
have an LMC-nominated, PCO-appointed deputising service liaison
officer that played a role in undertaking unannounced spot-checks.
I hope that you find this submission useful;
should the Committee request it, we are more than happy to expand
on any of the points raised.
Dr Laurence Buckman
Chairman
BMA General Practitioners Committee
4 March 2010
41 The Department of Health has selected the Primary
Care Foundation to support a national benchmark of out-of-hours
services. Details can be found here: http://www.primarycarefoundation.co.uk/page1/page1.html Back
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