How the NHS out-of-hours cover problem came about

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

Patients rights were outlined in 2009 by the NHS constitution which created a standard NHS complaints procedure.  This means that any NHS complaint should be investigated fairly and correctly other wise it could be refered to a judicial review. If a patient feels that their complaint hasn't been dealt with correctly then there are other measures available to make complaints about their NHS which is usually through authorities which oversee the NHS.