A new twist to the out-of-hours fiasco: Nurses cover for night GPs

By Daniel Martin for the Daily Mail
Updated: 20:23 EST, 2 May 2010



Out-of-hours care on the NHS is now so bad that thousands of patients are being treated by nurses instead of doctors because they are cheaper to employ.

A Daily Mail investigation has revealed that in four trusts there are more nurses on overnight shifts than doctors.

At seven more, there are equal numbers of GPs and nurses covering nights. Between them the trusts cover millions of people. In some areas, up to 330,000 patients are looked after by just one doctor at night.

The snapshot survey throws fresh light on the out-of-hours care shambles since 2004, when Labour allowed more than 90 per cent of family doctors to opt out of responsibility for their patients at evenings and weekends.

nurse

Thousands of patients are being treated by nurses instead of doctors as they are cheaper to employ

Primary care trusts (PCTs) have been forced to bring in locum doctors, many from overseas. The poor quality service was highlighted last year when an exhausted German doctor killed a pensioner on his first shift in Britain.

Now, the Mail survey reveals that many PCTs are relying on less qualified nurses to look after patients, rather than more expensive doctors. More than one in five NHS trusts cut funding for the out-of-hours service at the start of last month.

It also highlights a worrying postcode lottery of the level of out-of-hours care, with some PCTs spending 57p per patient while others spend £15.

Some areas are so overstretched that the chances of getting a home visit from an out-of-hours doctor are as low as one in 50.

PCTs say the nurses are highly trained, and can prescribe many more medicines than they used to. But critics argue that nurses often have to send people to hospital because they do not have the training to deal with many problems.

With confidence in out-of-hours services at an all-time low, the Daily Mail contacted all PCTs in Britain to ask about GP cover out of hours, and to what extent they were being supported by nurses.

nhs 24

There is a worrying postcode lottery of the level of out-of-hours care

Three GPs were responsible for almost a million people in Derby City and Derbyshire County PCTs overnight, while seven nurses were on call.

The PCTs defended the figures, insisting that on an average outofhours shift during the week, 151 calls are received resulting in 20 home visits.

They said five nurse practitioners 'see patients face-toface in exactly the same way as a GP treats a patient', while two nurse advisers gave telephone advice.

A spokesman for NHS Derbyshire County said: 'We have nurse practitioners, emergency care practitioners and nurse advisers in addition to the out-of-hours GPs.

'This is to ensure the most appropriate clinician is available to see the patient and that the most effective staffing model is in operation.

'We have enough clinicians for the volume of calls.'

In Brighton and Hove, just one GP covered a population of 284,872, aided by one nurse providing telephone advice who was also covering West Kent and East Sussex.

Four PCTs had one doctor on overnight to cover the entire area, with no other nurses or doctors on-call.

Peterborough PCT had one GP and three nurses on overnight duty. Alison Reid, Director of Care Pathways at NHS Peterborough, said: 'Self-care is the best choice to treat very minor illnesses and injuries. Many ailments and queries can also be dealt with by a pharmacist.

'Going direct to hospital or dialling 999 should only be for serious illness or injuries considered to be critical or life threatening.'

The number of complaints about out-of-hours services has doubled since the new contract came into force.

In 2002, before the new contract, there were 120 complaints about outofhours care. In 2008, there were 241. Over 2007 and 2008 there were 75 complaints concerning deaths, leading to 17 legal suits.

nurse

In four NHS trusts there are more nurses on overnight shifts than doctors

Conservative health spokesman Andrew Lansley said: 'Gordon Brown keeps talking about making it easier for people to see their GP but these disclosures show that Labour's mismanagement of the GP contract has left the public woefully short of GP access and support out of hours.

'I know that GPs themselves are very concerned about this and want once again to be more involved in delivering out-of-hours care. That's why we have set out plans to make GPs responsible for commissioning out-of-hours and GP services.'

BOTCHED DEAL THAT CAUSED CRISIS

Out-of-hours care has been one of the greatest failures of Labour's 13-year stewardship of the NHS.

The present creaking system is the direct result of a botched contract negotiated between GPs and the Government in 2003.

The British Medical Association, the doctors' trade union, was threatening not to sign a deal, and there were dark mutterings from many GPs that they might leave the NHS.

Boxed into a corner, ministers agreed to an overly-generous deal which not only granted GPs an enormous pay rise but also allowed them to opt out of responsibility for patients in the evenings and at weekends in return for a salary cut of just £6,000.

Ministers were shocked when more than 90 per cent took the pay cut, leaving the NHS with a massive problem.

When the new contract came into force in 2004, responsibility for the vast majority of out-of-hours care passed to primary care trusts.

They were forced to approach private companies and GP co-operatives to provide cover.

Some companies fly in doctors from overseas, even though they may have poor English.

Many PCTs were not up to the job and did not commission the cover required.

Patients' inability to get out-of-hours care has led to a massive increase in people turning up at hospital accident and emergency departments.

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