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Out-of-Hours GP Services

May I join the Minister in extending my sincere condolences to Mr. Gray's family? I thank the Minister for the courtesy of giving me sight of his statement prior to his making it at the Dispatch Box. I suspect, however, that it is with great reluctance that he has come before the House today and that he has done so only because of significant pressure. It needs to be said that good out-of-hours care is being provided in some parts of the country, but it is clear from the coroner's report into the terrible tragedy of David Gray in February last year, and from the additional report by Dr. Colin-Thomé and Professor Field released last Thursday, that there are significant failings in the provision of out-of-hours care in some parts of England, providing unsatisfactory levels of patient care and, ultimately, putting patients' lives at risk. There have been several tragic deaths, and we must all do everything we can to ensure that that never happens again. The Government's decision to allow almost all GPs to opt out of involvement in out-of-hours care in 2004 was a significant and serious mistake. The current structure of out-of-hours care is at best patchy and has been described by the Public Accounts Committee as ““shambolic””. The Government were consistently warned that there were ongoing failures in the system, with reports not only by the PAC but by the National Audit Office and by the Select Committee on Health, twice, highlighting serious concerns and failings, yet no effective action was taken. All those reports, and the two released last Thursday, are critical of the patchy provision of out-of-hours care. The list of defects and non-performance is extensive: increasing numbers of complaints about out-of hours care; primary care trusts failing to monitor the quality of care and not reviewing or assessing contracts; inadequate performance measurements; strategic health authorities not monitoring PCT performance, and in some cases not engaging in the process at all; out-of-hours care used too often as a holding bay; insufficient skills for commissioning out-of-hours services; some PCTs ignoring and shunning GPs' involvement and advice; a lack of clarity on responsibility between commissioners and providers; significant additional pressure and attendance at accident and emergency and pressure on ambulance services; little or no integration of out-of-hours care with urgent care; non-implementation of selection, induction and training of foreign doctors; very poor response times; and a lack of a coherent and consistent approach to the inclusion of doctors on the performers list. It is clear that there were failures at SHA, PCT and provider level. There were failures to assess foreign doctors' language, communication and formulary skills, to involve GPs in the commissioning of services, to monitor, review and assess out-of-hours care, and to assess and learn from patient experience. In some parts of the country, that litany of failures has been detrimental not only to patient care but to patient safety, culminating in the shocking death of David Gray. The Minister has said that he will implement all the recommendations of the Colin-Thomé and Field review. Will he do the same for the coroner's recommendations? What will be the time scale for the implementation of the recommendations of the review? In other words, what is the longstop date for its total implementation? What action will the Minister take to ensure that SHAs review PCTs' progress in that area? SHAs need to do more than just consider what action should be taken. How will he ensure that PCTs properly and regularly review out-of-hours contracts, involving local GPs and, I note with interest, including local GP consortiums? Rigorous monitoring should be taking place everywhere, looking at the quality of clinical decisions, the efficiency of call handling, the adequacy of staffing, doctors' training and patient outcomes. The Minister will be aware that the General Medical Council is very concerned about the ability of foreign doctors from within the European economic area to practise in the UK. It believes that"““the current legal framework is unsatisfactory””" and that"““the current system does not adequately safeguard patient safety.””" The Minister must ensure that he completes the immediate implementation of the Department of Health report ““Tackling Concerns Locally””, which has been collecting dust in the Department since March 2009. Will he address the concerns of the GMC and lobby for a change to EU law, to ensure proper skills and language testing for doctors who wish to practise in the UK? Will he consider including in the process of revalidation locums and doctors from the EEA who are working in the UK, and will he ensure that access to the performers list is tightened and that there is a much greater flow of information between PCTs and the GMC? As far as I understand from what the Minister said, there is still no mechanism in place to ensure that a doctor struck off in another EU country cannot practise in the UK. To put it mildly, this is not the Government's finest hour. It has taken the tragic death of Mr. Gray for action to be taken, despite persistent and consistent previous warnings. This is a serious situation that will be resolved only when the Minister accepts that in some geographical areas the system of out-of-hours care has failed; when, as the Royal College of General Practitioners recommends, a comprehensive review of out-of-hours care takes place; and when the Government accept, for the sake of patient care and safety, that responsibility for commissioning out-of-hours services must be with GPs.