Royal College expresses concern over transfer of out of hours GP services
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《英国医生杂志》
Professor David Haslam, chairman of the council of the Royal College of General Practitioners, has expressed concerns to the parliamentary health select committee over the "potential crisis" in GP out of hours services when responsibility for night and weekend cover is transferred to primary care trusts on 31 December.
Commenting on the readiness of primary care trusts for their new role, Professor Haslam said, "I think there is a general underestimation of the complexity of what goes on in an out of hours consultation."
Dr Mark Reynolds, chairman of the National Association of GP Co-operatives, voiced similar concerns: "People in primary care trusts are taking this job on with no experience of it and think things will be fine."
But the NHS Alliance, the main organisation representing primary care trusts, submitted written evidence stating: "Most trusts have the replacement of GP out-of-hours traditional arrangements in hand and are confident in alternative service provision."
Dr Ruth Livingstone of the alliance told the committee: "For primary care trusts it has been a tremendous challenge—some have risen to the challenge faster than others." She also disputed whether out of hours services had ever been organised properly.
Previously, GP practices provided out of hours care themselves, worked together in non-profit cooperatives to spread the burden of night and weekend work, or employed commercial GP deputising services.
Under the new GP contract doctors can hand over liability for out of hours services to primary care trusts. Those who do so will lose ?000 ($11 000; �9000) a year but will no longer be contractually obliged to provide 24 hour care to patients (BMJ 2004;328:247).
Where general practices opt out of 24 hour care primary care trusts will either directly manage services themselves or use commercial services and organisations evolving from the cooperative model.
The BMA expects most practices to opt out of responsibility for out of hours care but believes that many doctors will continue with some night and weekend work under separate arrangements. The BMA hopes that the opt out provision will help with recruitment of GPs.
The House of Commons Health Committee also asked witnesses whether more use could be made of the skills of other healthcare professionals in delivering out of hours services.
Dr John Chisholm, chairman of the BMA General Practitioner Committee, said: "It is important that all contributors to out of hours are brought together so that the response is a more integrated one. That does mean bringing together the ambulance service, accident and emergency departments, community nursing, social care, NHS Direct or NHS 24, as well as GP out of hours providers."
Professor Haslam supported moves to develop a mix of skills but had reservations. "You cannot substitute a paramedic an additional 12 week course for a GP," he said.
Mr Martin Shalley, president of the British Association for Emergency Medicine, thought that public perception of GPs?out of hours care had already shifted: "What we have found in emergency medicine is that our attendances over the last 12 months have increased by 13% to 15%. It may be because, from a patient抯 perspective, many of them believe that emergency care in a primary care setting doesn抰 exist outside of nine to five."
Dr Mike Sadler, medical director of Primecare, a commercial deputising service for GPs, also appeared as a witness before the select committee as part of its inquiry into out of hours GP services.(BMJ Bruno Rushforth)
Commenting on the readiness of primary care trusts for their new role, Professor Haslam said, "I think there is a general underestimation of the complexity of what goes on in an out of hours consultation."
Dr Mark Reynolds, chairman of the National Association of GP Co-operatives, voiced similar concerns: "People in primary care trusts are taking this job on with no experience of it and think things will be fine."
But the NHS Alliance, the main organisation representing primary care trusts, submitted written evidence stating: "Most trusts have the replacement of GP out-of-hours traditional arrangements in hand and are confident in alternative service provision."
Dr Ruth Livingstone of the alliance told the committee: "For primary care trusts it has been a tremendous challenge—some have risen to the challenge faster than others." She also disputed whether out of hours services had ever been organised properly.
Previously, GP practices provided out of hours care themselves, worked together in non-profit cooperatives to spread the burden of night and weekend work, or employed commercial GP deputising services.
Under the new GP contract doctors can hand over liability for out of hours services to primary care trusts. Those who do so will lose ?000 ($11 000; �9000) a year but will no longer be contractually obliged to provide 24 hour care to patients (BMJ 2004;328:247).
Where general practices opt out of 24 hour care primary care trusts will either directly manage services themselves or use commercial services and organisations evolving from the cooperative model.
The BMA expects most practices to opt out of responsibility for out of hours care but believes that many doctors will continue with some night and weekend work under separate arrangements. The BMA hopes that the opt out provision will help with recruitment of GPs.
The House of Commons Health Committee also asked witnesses whether more use could be made of the skills of other healthcare professionals in delivering out of hours services.
Dr John Chisholm, chairman of the BMA General Practitioner Committee, said: "It is important that all contributors to out of hours are brought together so that the response is a more integrated one. That does mean bringing together the ambulance service, accident and emergency departments, community nursing, social care, NHS Direct or NHS 24, as well as GP out of hours providers."
Professor Haslam supported moves to develop a mix of skills but had reservations. "You cannot substitute a paramedic an additional 12 week course for a GP," he said.
Mr Martin Shalley, president of the British Association for Emergency Medicine, thought that public perception of GPs?out of hours care had already shifted: "What we have found in emergency medicine is that our attendances over the last 12 months have increased by 13% to 15%. It may be because, from a patient抯 perspective, many of them believe that emergency care in a primary care setting doesn抰 exist outside of nine to five."
Dr Mike Sadler, medical director of Primecare, a commercial deputising service for GPs, also appeared as a witness before the select committee as part of its inquiry into out of hours GP services.(BMJ Bruno Rushforth)