Rectifying GP and out-of-hours cover problems within the NHS

The Government recently announced a new system of annual appraisals for GPs in which they will have their skills and competence tested. The new initiative was triggered by the investigation into Harold Shipman and eventually it will lead to all 150,000 practicing doctors needing to have their licences renewed by the General Medical Council (GMC) every five years. Incompetent or Medically negligent doctors face hearings or even losing their licence.

The Care Quality Commission (CQC) said in its report published last year that Primary Care Trusts (PCTs) must look at the quality of clinical decisions, the efficiency of call handling and the adequacy of staffing and doctors training in an effort to properly check the performance.

One crucial problem regarding overseas doctors is that 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 had to be taken against a doctor or other health professional. So a GP who has been struck off in say Italy is able to work in the UK or any other EU country undetected despite the fact the may have been medically negligent or found to be incompetent.

Indeed, this occurred in the case of Dr Ubani. A BBC Newsnight investigation found documents in Germany relating to the doctor, showing that he was guilty of malpractice and evidence of complaints about him dating back many years but all of this was not known by the English medical authorities prior to appointing him for what turned out to be his first and last locum shift in this country.

In fact Ubani failed in his first attempt to work in this country because of his poor command of English. He was later admitted to the performer's list of Cornwall and Isles of Scilly NHS, which apparently had less rigorous checks but did not get the opportunity to work there and took the fateful shift in Cambridgeshire a month later.

The General Medical Council, no doubt with the Daniel Ubani case in mind, has called on the European Parliament to change the current situation and create a statutory duty to share information. The British Medical Association (BMA) has joined in these calls, saying: "While the BMA agrees with the principle of cross-border patient mobility it is essential that there is a legal requirement for regulatory bodies in member states to exchange information about doctors' disciplinary records. In this way doctors who have been struck off or suspended will be prevented from travelling to other countries and treating patients."

The Government has stressed that care has improved since 2004, despite GPs having stopped providing out-of-hours cover (OOH). In terms of the situation following the Ubani case, it has said that GPs providing such care will be subjected to tighter controls, greater skills and knowledge testing. A new report, 'General Practice Out of Hours Services,' follows the review by Dr David Colin-Thome and Professor Steve Field and recommends improved induction and training and a national database of doctors covering OOH services.

This report provides a number of measures which it hopes the PCTs will follow. Among them is the recommendation that PCTs should review the performance management arrangements in place for their out-of-hours services and ensure they are robust and fit for purpose. It also recommends that the Department of Health should issue guidance to PCTs to assist them in making decisions about whether or not a doctor has the necessary command of English.

Primary Care Trusts have already been issued with interim guidance to assist them in complying with their obligation that all approved OOH GPs have a satisfactory knowledge of English. The Department of Health now hopes that by the end of this year there will be a model contract for PCTs to refer to when looking for OOH services. It also intends to ask GPs themselves for input into how their local OOH services meet the needs of their local communities.

The Conservatives, in the run up to the election, have said that they will challenge existing GP contracts in a bid to provide an improved service on evenings and weekends. Shadow Health Secretary Andrew Lansley said that a future Conservative Government would make GPs 'collectively responsible' for out-of-hours services, saying that they are best placed to ensure that patients are treated properly.

The Liberal Democrats, for their part, say that there should be a language and competence test for every overseas doctor wishing to work in the UK. Their Health spokesman Norman Lamb accuses the Government of knowing that the safeguards already in place were inadequate but not taking any action to improve them.

http://news.bbc.co.uk/1/hi/health/8493537.stm

The health service is never out of the headlines for long. The issue over out of hours care was soon replaced by the report into the appalling care given to patients at Stafford Hospital. With the election looming the three main parties will be putting forward their own future plans for the NHS and as out of hours care is still fresh in the minds of the electorate, it is highly likely to be raised at some point in the coming weeks. All politicians must strive to show that lessons have been learnt since the tragic death of David Gray.

NHS complaints should be treated fairly, but if complainants believe theirs has not they can progress their NHS complaint through other means, usually authorities which oversee them.