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It was predicted by many that handing over
out-of-hours (OOH) care
to the Primary Care Trust’s (PCT) would lead to problems and that has proved
to be the case.
The National Audit Office, investigating
in 2006, was highly critical, claiming that the system
of out-of-hours care was a shambles with escalating
costs, slow response times and a doubling in the number
of GPs coming into the country from Germany, France and
Italy.
There was considerable worry about the effects of a
vast increase in the number of foreign doctors,
particularly having regard to
patient safety and there
are many who say that the
death of David Gray at the
hands of Dr Ubani was an accident waiting to happen.
Doctors from other EU countries can practice in the
UK despite the possibility that they were struck off in
another EU country for
medical negligence or incompetence because current
European legislation means that there is no obligation
for an overseas regulator to inform their counterparts
in another country of any disciplinary action that has
been taken against a health professional.
Late last year the
Care Quality Commission
(CQC) also
looked into the system of out-of-hours services. The
Commission said it was concerned that PCT’s were not
effectively monitoring the performance of GPs in
evenings and weekends and that the safety of patients
could be compromised as a result.
There was also the fact that standards of care varied
enormously throughout the country. Research into
out-of-hours care across England showed huge
differences. The out of hours service in Suffolk for
example has been so overstretched that on some occasions
there have only been two GPs on call to serve the whole
county which has a population of 600,000 people. A
nine-month-old baby died in the county while his parents
waited for a call back from the GP. The parents of
Taylor Smith phoned up after their baby woke up with a
bright rash. They were told to wait for up to four hours
for a call from a GP but the child had contracted
meningitis and died from blood poisoning before the GP
had rung back.
Local GPs in Suffolk have written to the local PCT,
complaining about the OOH service and Dr Claire Giles,
chair of the Suffolk Local Medical Committee, has said:
“The patches covered by these doctors have got bigger
and bigger as the funding has been cut”. The problems
are certainly not limited to Suffolk. Across rural
England in particular the number of doctors on call has
dropped alarmingly. Alan Beith, MP for Berwick-on-Tweed
told the House of Commons in a recent debate that some
patients in Northumberland had to contact doctors at a
base 60 miles away leading to great delays in getting
seen by a GP out of hours.
The
Primary Care Foundation studied 80 primary care
trusts and found that only 16 of them reached the
Department of Health target of assessing 95% of urgent
cases within 20 minutes.
http://www.guardian.co.uk/society/2010/feb/02/nhs-trusts-out-hours-gp
A government report, conducted by Dr David Colin-Thome,
National Clinical Director for Primary Care at the
Department of Health and Professor Steve Field, Chairman
of Council,
Royal College of General Practitioners, has
admitted that there is unacceptable variation in the
quality of OOH services throughout the country. The
report, which was carried out in the light of the Dr Ubani case, has criticised some NHS trusts which it says
are breaking the law by failing to check whether foreign
GPs can speak good enough English.
The furore over David Gray’s death and the fact it
was at the hands of an OOH doctor on his first shift in
the UK and who, allegedly had a poor grasp of English,
brings reminders of the death of Penny Campbell in 2005
and perhaps highlights that lessons have not been
learnt. Penny Campbell died from septicaemia which was
not diagnosed despite six telephone calls and two face
to face meetings with an out-of-hours GP service during
Easter 2005.
A report into her death concluded that there had been
a ‘major systems failure’ in the care offered to her.
The report highlighted the actions of a GP but also
problems in how the OOH service was operating. At its
introduction the OOH care was supposed to be a ‘holding
bay’ until patients could see their regular GP but the
report said that the ‘safety netting’ which would have
enabled Miss Campbell to call back if she did not
recover was seriously flawed.
In fact each of her calls was treated as a single
incident and she had to explain her symptoms from the
beginning each time she called. The coroner in the
inquest into her death ruled that the doctors
contributed to her death because they failed to
recognise the seriousness of her condition.
The Department of Health described Miss Campbell's
death as a ‘tragic accident’ and conceded that lessons
needed to be learnt. However it denied it was a result
of any change to out-of-hours care. At the time, which
was about a year after the system of out-of-hours care
was introduced, a report from the
Public Accounts
Committee, criticised the government for ‘thoroughly
mishandling’ its introduction.
http://www.dailymail.co.uk/news/article-1249252/Complaints-GPs-soar-12-cent-ONE-year.html
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