Page last updated at 00:01 GMT, Thursday, 4 February 2010

Inquest verdict due over GP out-of-hours deaths

By Nick Triggle
Health reporter, BBC News

David Gray
David Gray was given a huge overdose of the painkiller diamorphine

A coroner is due to give his verdict into the deaths of two patients treated by an overseas out-of-hours doctor on his first NHS shift.

David Gray, 70, from Cambridgeshire, died in 2008 from an overdose of the painkiller diamorphine after being seen by German medic Dr Daniel Ubani.

Iris Edwards, 86, Dr Ubani's next patient, later died of a heart attack.

The nine-day inquest has heard evidence which raises concerns about GP cover during evening and weekends.

Dr Ubani was working for Take Care Now, the company which was running the NHS out-of-hours service in Cambridgeshire. The contract has now been terminated.

Although we cannot bring back our father we can use the lessons learnt from this tragedy in a constructive manner to make it safer for others
Dr Stuart Gray, son of victim

In April 2009, the German authorities gave Dr Ubani a nine-month prison sentence, suspended for two years, and he was ordered to pay a £4,500 fine for causing Mr Gray's death by negligence.

But he continues to practise as a cosmetic surgeon in the west German town of Witten.

The German conviction meant he could not be extradited to face possibly more serious charges in the UK.

Ms Edwards's case was not part of the criminal inquiry, although medical experts believe she was inappropriately treated and should have been sent to hospital.

After the death of Mr Gray, Dr Ubani later said in a letter to his sons that he was not familiar with diamorphine, because it was not routinely prescribed by doctors in Germany.

A subsequent report by the Care Quality Commission then raised further concerns about out-of-hours care.

The regulator looked at five trusts which used Take Care Now and warned they were failing to properly monitor services.

It said the variations in performance suggested it could be a nationwide problem.

'Less stringent'

The out-of-hours system changed six years ago after GPs negotiated a different contract.

It meant the responsibility for out-of-hours cover passed to local health managers working for primary care trusts.

The trusts have used a range of ways of covering weekends and evenings, including employing private firms to run the service.

In some places, foreign doctors have been used to cover shifts.

European legislation means doctors are free to work in different parts of the EU and are subject to less stringent checks than other foreign doctors arriving in the UK.

Speaking ahead of the verdict, one of Mr Gray's sons, Dr Stuart Gray, who is himself a GP, said: "The circumstances around the tragic death of our father have highlighted numerous systemic failures in both the UK and German health systems, as well as deficiencies in current European law.

"Although we cannot bring back our father we can use the lessons learnt from this tragedy in a constructive manner to make it safer for others by ensuring changes are made to rectify these serious inadequacies and failings."

The Department of Health has already carried out its own review of out-of-hours care in England.

It is expected to issue a series of recommendations for improving the service after the verdict.

The British Medical Association has warned the service has been starved of funds and different procedures are being used by local health managers to scrutinise doctors.

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