Failings in out-of-hours care

Published on Thursday 30 August 2007 01:20

AUDIT Scotland, the independent watchdog over how public money is spent, is a naturally cautious body. Its reports contain detailed analysis and evaluation of how taxpayers' money is spent, but with the minimum of comment. Usually, the facts are left to speak for themselves. So it is a sign of how seriously Audit Scotland considers the problem to be, that its latest report - on out-of-hours healthcare - is couched in uncharacteristically blunt language.

Since 2004, under their new contract of employment with NHS Scotland, GPs have been able to opt out of providing out-of-hours care in the evenings and at weekends. This provision, plus a generous increase in salary, was designed to meet a genuine problem - the growing shortage of local GPs, partly caused by doctors being lured abroad, where they could find more generous conditions and a better work-to-life balance.

Unfortunately, as a new Audit Scotland report outlines, this has led to fully 95 per cent of all GP practices deciding not to provide out-of-hours care and passing this responsibility to NHS boards. The result, says Audit Scotland, is "not sustainable, particularly so for the more remote and rural areas". The problem is that, without the ordinary GPs, the NHS health boards are struggling to find the staff and resources to provide out-of-hours cover.

GPs can "moonlight", but fewer and fewer are choosing to do so. Foreign doctors are being brought in from Europe on contract, but this is expensive and could result in language confusion. The bill for providing out-of-hours cover has rocketed to 68 million per annum on top of the original GP salary increases. This is forcing health boards to divert cash from other needs.

There is no doubt that the new GP contract has boosted recruitment. However, Audit Scotland is correct to recommend that "the way in which services are delivered must change if out-of-hours services are to be sustained". Otherwise, a cash crisis or a lack of available doctors, or both, will lead to patients suffering.

It is important that the Executive, NHS Scotland and the BMA sit down and work out how a better system of out-of-hours care can be provided. No-one is suggesting a return to the old days when individual GPs were constantly on call. That is bad for GP recruitment and it delivers the patient an inferior service. However, an alternative to the current patchwork system needs to be found. Is it not possible, for instance, for medical practices to provide collective cover without subjecting individual GPs to permanent long hours? Audit Scotland is warning that the current out-of-hours system is broken. We need to fix it.