NHS out-of-hours doctors under threat

Published: 4 February 2010
by TOM FOOT

FAMILY doctors who assess patients for urgent, out-of-hours medical care when GP surgeries are shut could be replaced by “cheaper” nurses.
NHS Camden has accepted bids for its revised £15million three-year “out of hours” contract from five private firms and the current provider, Camidoc.
The deadline closed on Friday and the winning bidder is expected to be revealed by March 1.
But last Thursday night, council chiefs ordered NHS Camden, the borough’s primary care trust, to halt the tendering process because the public have not been consulted on what they regard as “substantial changes”.
Regan Scott, from Camden Keep Our NHS Public, told the council’s health scrutiny meeting: “NHS Camden is pushing for a reduced quality service through the replacement of GPs – many of them experienced local family practitioners doing sessional work – by a cheaper nurse triage system. This is about costs. It will radically change the way the public are dealt with.”
Camidoc provides medical care for one million patients in Camden, Haringey, Islington, Hackney and the City of London between 6.30pm and 8am, Monday to Friday, and offers 24-hour cover at weekends and on bank holidays.
The service is considered a vital safety net for when surgeries are closed and provides over-the-phone medical assessments and face-to-face night-time cover with between two to 20 doctors on call at any one time.
NHS Camden is revising the contract because the Department of Health is introducing more neighbourhood health centres and setting up GP practices at the entrance of hospital Accident and Emergency departments.
The New Journal can reveal that under the new contract, nurses will be allowed to replace the majority of doctors in assessing patients.
Camidoc chief executive Michael Golding said on Monday: “The contract specification doesn’t say how many nurses should be used – it could be that we end up with a 50/50 split. We currently use nurses for about 5 per cent of assessments, on some days of the week, and we find that patients are often happy with that. But the main issue is that we believe doctors should be doing the bulk of the work.”
He added: “Nurses, while cheaper, often specialise in particular things, and another issue is that many of them are not qualified to prescribe. General practitioners have general knowledge. Doctors will also resolve the problem – while a nurse might pass the problem on to the accident and emergency. That increases the cost to the NHS as a whole.
“What is different about what we are saying at Camidoc is that we believe in GP-based work from the word go. It is about convincing them [NHS Camden] we can do this at the right price.”
NHS Camden is legally required to run a full public consultation on all “substantial” changes to the health service.
The council’s health scrutiny panel chairman Lib Dem councillor, John Bryant, said: “I think it’s substantial because of the access and delivery of services. We need to have an evaluation of the scheme. The tendering process should be halted.”
But Liz Wise, NHS Camden’s director of contracts, said: “Four other PCTs are very involved in this. If we don’t go out to tender we run the risk of an unsatisfactory service being in place. We would be in a very vulnerable position.”