Health Committee

6 August 2004                                      No. 31, Session 2003-04


GP Out-of-Hours Services - Report Published

Chairman David Hinchliffe said:

"GP out-of-hours services are a part of the NHS that have not, historically, attracted high levels of attention, either from the media or the Government. However, they are an absolutely integral part of the NHS. The scale of the service they provide is considerable-nine million people receive GP out-of-hours care every year, and the 'out-of-hours' period in fact accounts for two-thirds of each week. GP out-of-hours services also play a crucial role in controlling demand on other parts of the NHS, such as A&E and ambulance services-one group of GPs told us that without an effective out-of-hours service, emergency services in their area could have to cope with an additional 25,000 patients every month.

Up until now it has been the responsibility of individual GPs to provide out-of-hours care for their patients. But from 31 December 2004, GPs will be able to opt out of this cover, meaning responsibility for out-of-hours services will fall to their local Primary Care Trusts. The BMA told us that as many as 90% of GPs are likely to opt out.  This will mean a large scale change across the country in the way out-of-hours services are managed, funded and in some cases, delivered.

We were well aware when we began this short inquiry that attempting to evaluate the likely impact of changes that have not yet taken place can only ever be an inexact science. As this is also an area that directly impacts on people's professional lives, we have also been alert to the fact that that evidence will reflect professional standpoints and interests, and have taken care to weigh our evidence accordingly. We plan to maintain a watching brief on this area as the new changes take effect over the coming months and years. However, I hope that our inquiry and Report will help advance the debate in this area in the run up to the changes to out-of-hours services, and that the timing of our inquiry will allow the Government and the NHS a brief pause for reflection on the risks and opportunities that lie ahead before the changes to out-of-hours services are implemented.

We have heard a unanimous view from our witnesses that the handover of responsibility for providing GP out-of-hours services from individual GPs to PCTs represents a very welcome opportunity to redesign services so that they are more efficient, and, most importantly, deliver a better quality of service to patients. In some parts of the country PCTs, service providers and GPs are already working together to make the most of this opportunity. However, our evidence has also raised several areas of risk surrounding this transfer:

PCT readiness for their new responsibilities-our evidence suggests that PCTs are in varying states of readiness across the country. Some witnesses argued that this important issue was being managed at too junior a level within PCTs, and that PCTs may not be sufficiently aware of difficulties being experienced on the ground-one witness argued that it could seem at times as if PCTs were operating in a different 'universe', assuming everything was fine. Equally, PCTs may not be working together collaboratively enough, potentially leading to duplication and overlap.

Funding-despite extra resources from the Government, many PCTs still appear to be facing significant gaps between the funding that will be available for GP out-of-hours services, and what these services will actually cost to deliver once GPs are paid a market rate for their time. We have recommended that the Department of Health monitors the financial arrangements for GP out-of-hours services closely, and we will keep a watching brief on this through our annual Public Expenditure Inquiry.

Workforce-although GPs are likely to continue to form the backbone of future provision of out-of-hours services, and are the NHS's main source of expertise in this area, there is considerable uncertainty over the how many GPs will want to continue providing out-of-hours services. We strongly support the involvement of different professional staff in delivering out-of-hours services, including nurses, paramedics, mental health professionals and social workers. However, recruiting and training a new multi-disciplinary workforce will take time and investment, and we argue that the Government must make sure PCT plans take full account of this. We have also recommended that PCTs should be encouraged to work collaboratively with GPs, including those in co-operatives, and to provide the flexibility and support, as well as the financial incentives, necessary to retain a motivated GP workforce.

NHS Direct-NHS Direct clearly has the potential to play a useful role in the delivery of out-of-hours services. However, NHS Direct will have substantially to increase its capacity in order to cope with this burden. We are also concerned that full integration of NHS Direct and GP out-of-hours services could introduce unnecessary delay and increase referrals to other parts of the NHS. We have recommended that alongside their work to develop capacity, NHS Direct should work collaboratively with others, including GPs, to develop and refine their referral protocols to ensure this does not happen.

Information for patients-accessing healthcare outside normal working hours currently involves negotiating a maze of different services and telephone numbers. Clear information should be available to everyone who needs it, setting out what local NHS services are available where, in order to help patients make informed choices on how to access out-of-hours healthcare. We have recommended that the Government should ensure PCTs provide information on NHS services to their local populations on a regular basis, and keep people informed of any changes that may occur as a result of the handover of responsibility for out-of-hours care.

Quality of services-above all, it is vital that changes to GP out-of-hours should not compromise the quality of care delivered to patients out of hours. We welcome the introduction of quality standards for all providers of GP out-of-hours services, and we recommend that a broad-brush assessment against current quality standards is conducted prior to the handover of responsibility to PCTs, in order to provide a baseline against which performance under the new system can be measured.

Community hospitals-although providing services to community hospitals is a separate issue from GP out-of-hours services, we have heard evidence suggesting that the handover of responsibility for GP out-of-hours services from GPs to PCTs may prompt some GPs to re-evaluate and perhaps to withdraw the services they currently provide to community hospitals. It is vital that the extremely valuable service provided by community hospitals is not jeopardised, and we have asked the Government to ensure that this is resolved as a matter of urgency." 


The Health Committee will publish its Fifth Report of Session 2003-04 on GP Out-of-Hours services (HC 697-I) on Friday 6 August 2004 at 00.01 am.

Please note there will be no press conference.

Confidential advance copies of the report, which will be embargoed until 00.01 am on Friday 6 August, will be available for collection on Thursday 5 August between 11 am and 12 noon from the reception desk at Westminster House, 7 Millbank, London SW1. Advance copies of the report will also be made available to the Press from the Press Gallery, House of Commons at 11 am on Thursday 5 August.

Witnesses' copies will be posted to them.

Volume II of the Report (oral and written evidence) will also be published at 00.01 am on Friday 6 August.

NB     There will be no circulation of Volumes II and it will not be available from the Committee Office.

Notes to Editors

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The Health Committee is a Select Committee of the House of Commons. It is appointed under Standing Order No 152 to examine the expenditure, administration  and policy of the Department of Health and associated public bodies. The Committee has power to send for persons, papers and records.