MPs slam cost of GPs out-of-hours service

25 May 06
A committee of MPs has condemned the Department of Health's contracting and negotiation arrangements for GP out-of-hours services as 'scarcely believable', and 'a concealed pay rise for GPs'.

26 May 2006

A committee of MPs has condemned the Department of Health's contracting and negotiation arrangements for GP out-of-hours services as 'scarcely believable', and 'a concealed pay rise for GPs'.

Giving evidence to the Commons Public Accounts Committee, acting NHS chief executive Sir Ian Carruthers admitted that, more than a year into the new service, the DoH was still uncertain as to whether it wanted out-of-hours services to be open to urgent cases only, or to all.

'At this stage we haven't defined whether it's urgent or not… we recognise now that it is an issue,' he said.

The lack of clarity was brought to light in a recent National Audit Office report. This found an 'ongoing confusion' amid 'many providers and commissioners' as to whether primary care trusts were expected to contract out-of-hours services to meet all demands, 'no matter how minor the injury or illness' or just those classified as 'urgent'.

Greg Clark, Conservative MP for Tunbridge Wells, said it was unclear how the DoH could ensure that the new out-of-hours services offered value for money, if it wasn't even clear what they were supposed to be doing.

The new arrangements replaced services previously the responsibility of GPs, and came in at £70m over budget.

Clark told Carruthers: 'These aren't semantic issues… commissioners and providers would like the department to decide which kind of service they should provide. It's scarcely believable you haven't done it already.'

But Carruthers said the arrangements were a good deal for the NHS as they took away one of the most unpopular aspects of GPs' work and so helped address doctors' recruitment and retention.

Under the new arrangements, GPs agreed to give up an average £6,000 of income in exchange for losing responsibility for providing out-of hours services, which the DoH calculated to cost £9,500 per GP. Actual costs came in at nearer £11,600 per GP.

Swansea West Labour MP Alan Williams told Carruthers: 'You gave the GPs a concealed pay rise of £3,500… this is what it is all about.' And Ian Davidson, the Labour MP for Glasgow South West, said: 'It's an extortionate bargain, in fact, it's not really a bargain at all.'

Carruthers denied the accusation, but admitted that with hourly pay rates for GPs now offering their services back to out-of hours services ranging from £19.35 to £141.00 for the same shift, 'the [pay] position of GPs was maximised in some areas'.

Clark added: 'GPs are laughing all the way to the bank.'

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