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Last Updated: Wednesday, 14 March 2007, 08:06 GMT
Out-of-hours GP reforms attacked
Many GPs have opted out of evening and weekend work
The government "thoroughly mishandled" the introduction of the new system for out-of-hours health care in England, a group of MPs has said.

A public accounts committee report found that preparations were "shambolic" and that only GPs had benefited from the new arrangements.

It said the service was now improving, but was still not good enough.

Health Secretary Patricia Hewitt said there had been some problems, but eight out of 10 patients were satisfied.

'Their job'

She accepted there was still "plenty of room for improvement" but said the government did not need to lean on primary care trusts to get out-of-hours services right.

This hands-off approach to the costs of out-of-hours care was good news for the doctors but no one else
Edward Leigh
Public accounts committee

"We have made it absolutely clear that's their job. Most of them are doing it very well. Some of them could do it better," she said.

And she denied that the department had got it wrong in taking a back seat during the negotiations,

Prior to April 2004, GPs were responsible for providing out-of-hours care between 6.30pm and 8am on week days, and over the weekend.

Under the new system they were able to opt out of this duty in return for giving up an average of 6,000 per year.

Responsibility for out-of-hours care would then pass to the local primary care trust.

One leading member of the British Medical Association negotiating team has admitted that they were shocked at just how good the deal was for doctors.

'Strong incentive'

The committee blamed the Department of Health for not taking a direct part in negotiations over the new system.

Committee chairman Edward Leigh MP said: "This hands-off approach to the costs of out-of-hours care was good news for the doctors but no-one else.

"They were given a strong incentive to opt out and a disproportionate amount of taxpayers' money is now having to be spent to provide the replacement out-of-hours service."

MPs also criticised the Department of Health for failing to explain whether the service should be only for urgent care, or all health needs.

And they warned that the new system was costing 70m a year more than had been predicted.

They criticised the end of Saturday surgeries, and said access to care in some areas was difficult and slow.

'Not acceptable'

Dr Hamish Meldrum, chairman of the British Medical Association's GPs Committee, agreed many out-of-hours services left a lot to be desired, but said GPs were being unfairly criticised.

"When, with the full agreement of the government, primary care organisations took over responsibility for providing the out-of-hours service and in some places failed to make a good job of it - they try to blame the GPs," Dr Meldrum said.

"It's not right and it's not acceptable."

The Department of Health has now launched a "clinical audit toolkit" designed to help doctors, nurses and call handlers deal with out-of-hours care more effectively.

But Liberal Democrat health spokesman Norman Lamb MP said: "The effect of this mess is that A&E services will be swamped by patients who don't know where else to turn."

Stephen O'Brien, for the Conservatives, said: "The government has failed on out-of-hours provision. Everyone, up and down the country, is suffering because of it."

Patricia Hewitt on the out-of-hours service

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