Page last updated at 01:17 GMT, Thursday, 14 January 2010

Out-of-hours GP service 'failing'

By Matt Prodger
BBC Newsnight

Dr Ubani was on his first shift in the UK

At one end of a quiet street in the Cambridgeshire village of Manea is the local doctor's surgery.

At the other, barely 50 metres away, is the house where 70-year-old David Gray lived.

The surgery was closed, as usual, on Saturday, 16 February 2008.

That was Mr Gray's misfortune, because the out-of-hours doctor who arrived at his home to treat him for an ongoing kidney complaint killed him with an overdose of the painkiller, diamorphine.

By coincidence, David Gray's son is also a GP, but he says no doctor he has ever worked with would have made such an error.

"It's such a fundamental error that I can't believe that a qualified doctor would commit it.

"In fact even a student nurse would know that a 100mg dose of diamorphine would kill a patient."

Dr Daniel Ubani was German and on his first and last full shift as an out-of-hours doctor. He later admitted that in 21 years of experience, he had never used diamorphine.

I don't think anybody comes out looking good whether it is the PCT, the locum agency, the provider and the doctor himself
Steve Field, Royal College of General Practitioners president

But the mistake he made that day was just the tip of an iceberg of failures in a system administered by primary care trusts that is supposed to provide safe medical cover when the local GP is off duty.

It prompted a review headed by Steve Field, president of the Royal College of General Practitioners.

"In this case, it appears it was a multiple systems failure," he said.

"I don't think anybody comes out looking good whether it is the PCT, the locum agency, the provider and the doctor himself.

"The whole thing was appalling and we need to learn lessons from that, and I believe we are doing now."

Our investigation began not in England, but in Germany.

Dr Ubani runs a clinic called the Queen Idia in the town of Witten.

The sign outside his clinic says he is a practitioner of anti-ageing medicine and cosmetic surgery.

We have seen court documents from 2006 which show he was guilty of malpractice, evidence of complaints about him dating back to the mid-1970s and questionable references testifying to his experience.

All of this was unknown to the English medical authorities in 2008.


Under EU law, a GP certificate from any member country has to be accepted as proof of their fitness to practise.

And Dr Ubani had, and still has, his German one.

Niall Dickson, head of the General Medical Council, wants all EU doctors, like those from the rest of the world, to be tested before they practise in the UK.

"As far as outside the EU is concerned our view is that we have to test whether these doctors are competent or not and whether they're able to speak English.

"Within the EU there is an assumption that there is an equivalence across the European Union and we are not able to challenge for example whether a particular country's regulator is working effectively or not.

"And secondly we're not able to test whether they can speak English or not."

An investigation is underway into the out-of-hours provider, Take Care Now, which employed Dr Ubani on behalf of NHS Cambridgeshire.

The doctor assigned to provide induction for the Dr Ubani wrote on his form that he was too busy to assess him properly, but signed him off anyway. A day later David Gray was dead.

Freedom of information requests

There were further problems. British police failed to arrest Dr Ubani and when prosecutors later tried to extradite him they were told he had already been convicted in Germany for the death, fined 5,000 Euros and allowed to continue practising.

Research into out-of-hours care across England, obtained under freedom of information legislation, show large variations in the quality of provision from trust to trust.

For example, of half the primary care trusts in England examined by the Primary Care Foundation, only 6% of them hit the Department of Health target of assessing 95% of urgent cases within 20 minutes.

The vast majority are below standard on the measurement. And depending on where in England you live you have anything between a 1% and a 62% chance of your illness being deemed urgent by the out-of-hours service.

Since GP's were able to opt out of out of hours care in 2004, there has been a shortage of doctors to do the work, so agencies - and foreign doctors - plug the gap.

David Gray's family are taking legal action against those they hold responsible for his death.

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