Chiefs in pledges on out-of-hours doctors

In yesteryear it used to be so straight forward – if you fell ill the only option was to pick up the phone to your doctor and just wait until they could fit you in.

Things are a little different nowadays with the advent of walk-in health centres, special telephone numbers to call for advice and the launch of dedicated out-of-hours coverage for whole towns.

The changes have seen access to help for those who need it improved beyond all recognition.

But in recent weeks fears have been mounting about just who is providing out-of-hours care.

It follows the publication of a report into the death of a Cambridgeshire pensioner treated by an out-of-hours locum doctor from Germany working his first shift in the UK.

The health watchdog the Care Quality Commission said it fears primary care trusts (PCTs), which commission out-of-hours services, may not be effectively monitoring their performance and risk failing to spot patient safety concerns as a result. And the Department of Health is writing to all PCTs asking them to review their monitoring arrangements.

Health chiefs in the West Midlands say patients can be assured that it could quite easily be a doctor from their own surgery looking after them out-of-hours.

PCTs, which run health services locally, each spend more than a million pounds a year to run the service after a contract negotiated between the British Medical Association and the Government in 2004 allowed doctors to opt out of providing care outside normal hours.

Now, each PCT across the region and the country, commission out-of-hours services from a range of organisations including private firms, GP co-operatives and their own in-house teams.

And health chiefs in the West Midlands say much is being done to ensure the out-of-hours service is running as it should be.

John Wicks, director of commissioning and strategy at South Staffordshire PCT, said: "It is essential that our patients receive high quality, safe care around the clock and to ensure that all our providers meet our high standards, including our out-of-hours providers, we hold regular quality performance meetings with them to ensure that services are robust and to take action if services need to improve. Any GP working for out-of-hours providers are subject to the same regulatory checks as all other doctors working General Practice in England and employers have a legal duty to ensure that all doctors whom they appoint are fit to practice."

Lynne Allen, director of primary care for Wolverhampton City PCT, added: "The out-of-hours service has run successfully for many years and has a very stable workforce.

"Also, because most of the GPs working for the service also work in Wolverhampton practices, they are very familiar with the city and its patients and there is an excellent liaison system between daytime GP services, community nursing services and the out of hours service regarding continuity of care for seriously ill patients. The PCT is responsible for the performance management of its contract with Wolverhampton Doctors on Call (the city's out-of-hours service) and meets monthly with the organisation to ensure it is meeting all the current national standards for out-of-hours care.

"This includes assurance on quality and that it is providing a safe service to patients.

"The PCT and Wolverhampton Doctors on Call also work very closely together to ensure that only GPs fit to practice are employed in the service and we want to reassure local people that what has happened elsewhere is unlikely to occur in Wolverhampton because of the stringent controls already in place and the service's use of local doctors." Spokeswoman for Dudley PCT Rebecca Marsden said: "NHS Dudley has a robust monitoring process in place for all providers of healthcare locally, including the GP out-of-hours contract.

"We have a close working relationship with the GP out-of-hours provider for the borough and maintain regular contact to ensure the requirements of the contract are fulfilled.

"NHS Dudley will review the contract monitoring process in light of national recommendations to ensure the highest quality of care is delivered by all healthcare providers in Dudley."

Professor Steve Field, chairman of the Royal College of General Practitioners, who is also a GP in central Birmingham said the Birmingham and District GP Emergency Room (Badger) was a success others should follow. He said: "Badger is a success is due to excellent clinical leadership.

At Badger they are rigorous about high quality and it is a model others could follow."