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Sorry 5.28, I disagree. GPs experienced in out of hours care can deal confidently in all scenarios presented. I consider myself one having worked since 1993 through all the changes since my own practice did its own on-call, though co-operatives, OOH providers and now thre first few weeks of 111.

Three differences now. First Nurses have become the major clinicians supported by cumbersome computer programmes. Most have trained but have limited experience , are risk averse, and spend much time deciding to let someone else take the decision, often a doctor in the end, and more often than before a paramedic via 999. Second, much less GP involvement and hence younger GPs are not developing the skills and experience. Finally, the good old public who can do no wrong when it comes to health. Their demands are met , they learn bad behaviours and demand more and more. This group consult more than ever outside normal hours, fuelled by the press scare stories (didnt have children vaccinated with MMR now every rash is Measles !), these undue demands load the system even more, the respected GP firmly and fairly adjusting help-seeking behaviour modification a thing of the past.This all a recipe for melt-down.

Along comes NHSD, the supernumery risk averse OOH advice supplier , bids for 111, ironicallybecomes the first non independant sector out of hours community provider for decades ( GPs of course being independant companies), and they get it so wrong.Meanwhile the independant sector out of hours providers with GP management and experience slot into 111 with ease ( see Northern Doctors Urgent Care).

Solution - give GPs the a proportion of the masses of extra funding pumped in when they lost OOH responsibility, include nurses with appropriate roiles to their experience, and start to educate the public again, both in and out of hours.

Finally, the problem with the whole NHS, take the politicans out the equation - the recent rant by politicans to blame GPs for this mess is laughable, fed by inaccurate garbage from DoH. The political cycle has much to answer for!