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Last Updated: Friday, 25 May 2007, 11:52 GMT 12:52 UK
Q&A: GP out-of-hours care
Questions have been raised about GP out-of-hours care by an inquiry into the death of a woman.

Family doctors opted out of providing night and weekend care three years ago, but have patients suffered?

Stethoscope
Out-of-hours care changed three years ago

What has happened to GP out-of-hours care?

As part of the new GP contract, which was introduced in 2004, family doctors were allowed to opt out of night and weekend care by sacrificing 6,000 a year in their pay packets.

But the drop was more than compensated by huge bonuses doctors have received for hitting targets for patient care.

Unsurprisingly, nine in 10 GPs decided to stop doing nights and weekends. Although in practice, they had been scaling down the amount of work they did in recent years by sharing the responsibility with neighbouring doctors.

Where GPs did relinquish responsibility, health managers working for primary care trusts, which pay for local services, were charged with finding alternative arrangements.

The majority have opted for GP co-operatives, not-for-profit organisations which are run by GPs.

However, private companies have also got in on the act, as have partnerships of nurses, ambulance crews and doctors.

What happened to the woman at the centre of the inquiry?

Penny Campbell, a 41-year-old mother-of-one from north London, fell ill over the Easter break in 2005 after undergoing a routine operation.

She spoke to eight different doctors from the out-of-hours provider Camidoc over the four-day break, but none diagnosed her septicaemia.

She was eventually taken to the local A&E where she died.

An inquest last year concluded the lack of diagnosis contributed to her death.

Does the case have wider implications for the system?

The local bodies involved - both Camidoc and the four primary care trusts which commission the GP co-operative - were heavily criticised.

They have all promised to learn the lessons from Ms Campbell's death.

But the inquiry also said there were wider implications for the rest of the NHS.

It said there was "confusion" over the exact role of out-of-hours care and whether it was really there for urgent care.

The investigators said all too often there was a perception that cover was just a "holding bay" until full GP operations resumed.

This is the crux of the issue. Patients complain there is no continuity of care and quite often they are left for hours waiting for a doctor to arrive.

In turn, many GPs providing out-of-hours care say there are being squeezed financially by NHS trusts desperate to save money.

There is also a question of whether the GP co-operatives and other groups now responsible for care were ready for the responsibility.

Most of them were completely new organisations or relatively small and were suddenly asked to cover areas stretching hundreds of miles.

What is the solution?

This is the tricky bit, there is no consensus.

The partner of Ms Campbell, Angus MacKinnon has called for a return to the old system.

But doctors have pointed out that it was far from perfect, with doctors working through the night and then expected to be in their surgeries during the day.

Opposition parties have called on prime minister-in-waiting Gordon Brown to make out-of-hours care a top priority when he takes office in June.

The Lib Dems have said there are no easy solutions, but improvements are needed.




VIDEO AND AUDIO NEWS
Penny Campbell's partner speaks about her care



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