Revealed: the contents of the out-of-hours review (my predictions, at least)

By , Tuesday, 2 February 2010, 6 Comments
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The interview everyone was talking about last week (or at least that’s how it seemed to me) was GP newspaper’s exclusive with health secretary Andy Burnham.

I joined GP in November 2000 and it’s the first time since that we’ve had half an hour with the person at the NHS helm.

I’m taking a break from putting together GP‘s Letters page as I write this but it’s fair to say the response to the video highlights, video teaser, splash, focus and blog has been phenomenal.

It’s the most commented story on our website and look out for next week’s GP Letters page, as well as our 5 February edition, for more GP reaction to it.

This week, however, it’s unlikely to have escaped your notice that the current state of out-of-hours care is the talk of the media.

The DoH is planning to release the out-of-hours review it commissioned last year at the conclusion of the inquest involving Dr Daniel Ubani, probably on Friday.

So what should we expect the contents of the review to include?

1. Well, primary care minister Mike O’Brien is determined to make GPs more responsible for out-of-hours care. What will be interesting is how much more responsible? Labour thinks commissioning responsibility should be voluntary while the Tories believe it should be compulsory.

On Monday Healthcare Republic reported that the PCT that put Dr Ubani on its performers list was not carrying out adequate English-speaking checks but is now. The O’Brien quote from this story about the ‘unacceptable variation’ in PCT-provided out-of-hours care was all over the nationals on Tuesday.

2. One of the out-of-hours review’s authors is RCGP chairman Professor Steve Field and last year it wanted tougher criteria for EU GPs to gain a place on primary care organisation (PCO) performers lists, including a supervision period, and GP input to commissioning out-of-hours services.

3. The RCGP and the GMC were also calling for an overhaul of European law on hiring EU doctors for shifts in the UK.

This would mean changing the 2005 European directive on cross-border healthcare, which prevents regulatory bodies such as the GMC from testing EU doctors’ language skills and competency, but lets PCOs do so.

The directive says all member states must recognise the medical qualifications held by doctors from within Europe.

But what do you think about out-of-hours care, how it should be improved and what the contents of the review might be?

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  • Cheryl Vander

    The question is not about speaking English adequately (which is highly subjective anyway) but is about ensuring that training, and in particular pharmacological training to iron out differences between EU prescribing and EU countries, is completed before that doctor can be accepted onto the performers list. A period of mentoring by a registered GP (that is, already working in the NHS) for approximately 25 patient interventions should also be in place. The shifts would therefore be provided at a lesser rate of pay because of the supervisory element to them. Provision for concerns by that GP on any such supervisee should be delivered to the commissioning agent who then takes the risk about whether to continue to commission that particular trainee’s service. Our GPs have to undergo rigorous training and supervision, why should it be so different with primary care medical help out of hours? Or is our current strategy really saying to the British population that they are ‘lucky to get any service at all after hours’.

  • Neil Durham

    Some good points Cheryl. Although I’m not sure the idea of paying both a supervisor and a trainee GP would go down particularly well with those offering out-of-hours care. Aren’t out-of-hours services traditionally under-resourced?

  • Martin Gray

    There will always be a problem with providing OOH services, not least because GPs have opted out of having that burden of care after decades of doing so. It appears there is a ‘force’ at work to return to the old system but without admitting failure. I work in A&E for the OOH service providing primary care streaming from 1000 to 2200; many of the patients that present at A&E with problems that should be dealt with by their GP do so because, and I quote, ” I can’t get an appointment for weeks”. Although there are other services available to them via the Walk In Centre or the OOH GP service they don’t seem to know how to access these resources. Perhaps this is one initiative that has proved successfull, and reduced the workload on A&E staff, and should be adopted by other OOH services. It would certainly see an improvement in OOH provision, as would ANPs being used to do home visits. Why use foreign doctors when we already have a workforce with the advanced skills to do much the same role?

  • Neil Durham

    Interesting points Martin. Should advanced nurse practitioners be used to do out-of-hours home visits? I don’t know the answer. Aren’t some ANPs doing that already? ‘Why use foreign doctors when we already have a workforce with the advanced skills to do much the same role?’ is a very good question.

  • irene bainbridge

    Some questions need to be answered:
    1.why did the locum only have 3 hours’ sleep before starting his shift?
    2.why was his pre-work assessment unfinished?
    3.why wasn’t it known that he had been rejected by another PCT?
    4.why did he have 100mg morphine in his emergency bag?
    5. How can we prevent this scenario from recurring?

  • Neil Durham

    Excellent questions Irene. Look out for a more in-depth look at the Ubani case in GP next week. If you can’t see a copy of GP, the story will be here online on Healthcare Republic in the GP section from Thursday.

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