Forcing GPs to provide out-of-hours care may not be the best way to rebuild public confidence in these services. Instead, the government should look to other providers to fill the gap

Out-of-hours care has had a rough ride following two surveys and a report highlighting the apparent crisis in evening and weekend services. The public must be wondering how things have been allowed to go so wrong, but is this a true reflection of what is happening?

The first bit of bad news came with the Royal College of Pysicians' report Acute Medical Care: the right person, in the right setting, first time. The report found that patients are forced to go to hospital for reassurance because out-of-hours care is largely inadequate and inflexible.

This was followed closely by a survey of 880 GPs, 67 per cent of whom thought standards had dropped since primary care trusts took over provision of services. Finally a survey of 12,000 patients in seven countries by US think tank the Commonwealth Fund declared that 55 per cent of patients had difficulty getting access to GP care on weekends and nights.

It would be foolish to dismiss the surveys and the report, but is the reality as bad as the press would have us believe?

Innovative care

In reality, there are comprehensive national guidelines on out-of-hours services. In addition to national targets and quality requirements, providers must be able to demonstrate that they have focused on patient safety by undertaking comprehensive risk assessments.

It is worth taking a moment to compare the sort of services that are delivered out of hours with those delivered in hours. Over the August bank holiday weekend, 99 per cent of patients covered by our contracts in East Cambridgeshire, Fenland and Suffolk PCTs were able to speak to a clinician within a target of 20 minutes for urgent calls.

GP claims that the quality of care has fallen since PCTs took control should be balanced by the acknowledgement that in most cases this care is still being provided by the same local GPs, albeit contracted to other providers.

High-tech systems

There is a strong argument that sophisticated telephony and IT systems, quality assurance and performance management mechanisms and multidisciplinary teams operated by the leading providers have significantly enhanced access and quality. Some providers may use other health professionals in place of GPs as part of balanced multidisciplinary teams but as long as the quality guidelines are met by the provider and enforced by the commissioner, there should be no detrimental impact on patient care.

Given that GPs appear unwilling to take back out-of-hours care - despite the overt pressure that has been exerted on them over their pay through the media - it is clear to me that other providers have a role to play.

Existing out-of-hours providers and commissioners are actively driving service improvements and addressing the needs of patients. The government has to look at the opportunity costs of reversing out-of-hours service delivery by requiring individual GPs to take on out-of-hours duties again. Does it really want exhausted GPs unable to meet increasing in-hours demand, plummeting GP morale, and huge difficulties co-ordinating unscheduled care services?

It would be shortsighted for the government to think that battling with GPs is the only way to win back credibility and deliver out-of-hours services that are fit for purpose.