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Out-of-Hours GP Services

I certainly agree with the hon. Gentleman that we must ensure that we do all we possibly can so that this sort of incident never happens again. That is why we responded to a series of reports and ensured that after the Carson review on out-of-hours services, we changed things—it was clear that the system that existed before 2004 was unsafe; therefore, changes were put in place. We do not want a situation in which we return responsibility to GPs for the management of out-of-hours care, as appears to have been suggested. Dr. Laurence Buckman of the British Medical Association has been very clear on that. He said:"““The old system meant many doctors were tired and therefore potentially dangerous to patients and it is for that reason that the BMA, and the GPs it represents, would resist a return to doctors taking back personal responsibility for delivering care out-of-hours.””" On another occasion, he said:"““The current out-of-hours system desperately needs improving, but we can't go back to where we were before 2004 where doctors were on call 24 hours a day, meaning many were operating in a constantly sleep-deprived state.””" We need to ensure that we deal with some of the issues that exist in the current system. I think we all, as parliamentarians, need to confront the issue of decentralisation of power. We have been pushing down responsibilities to PCTs. That is all very good, and there is a broad consensus in the House that that should happen—the closer to the patient the better—except some PCTs are more capable than others of doing a good job. That presents us with the question how best to manage that. We have taken the view that we need to bring about two changes. First, we need much more central involvement by the Department of Health in ensuring that PCTs have minimum standards, through a model contract. All PCTs must ensure that providers comply with that contract. Secondly, we need to get local GPs more involved—that does not mean giving responsibility back—so that they can monitor the quality of the out-of-hours service that is being delivered. The hon. Gentleman set out the concerns expressed in the report by Dr. Colin-Thomé and Professor Field. I remind him that that report was commissioned not after the coroner's report last week, but on 23 September last year. Indeed, discussions on it took place with those involved before that time, because we knew that we needed to ensure that we improved out-of-hours care. I want to have further discussions with the doctors' organisations on some of the coroner's recommendations, but in a broad sense, we accept them. We must go through some of the detail with the doctors' organisations on how that will be done. When can we put those changes in place? I have said very clearly to officials that I want it done by the end of the year. I want to be sure that we have got the system right by then at least. I was asked how that would be monitored. For the next six months PCTs will be required to have on the agenda of every board meeting, at least once a month, the quality of out-of-hours care and its improvement. That will be monitored by the SHA. Thereafter, PCTs need to take a higher level of responsibility for it. There are three checks on foreign doctors from the EEA. First, the GMC checks their medical qualifications. Secondly, since 2004 the PCT is responsible for checking that they speak English and that nothing is known about them that undermines their medical capability. Thirdly, the employers are responsible for ensuring that the GPs whom they employ not only speak English, but are clinically competent. In some cases it is clear that some of the PCTs have been a weak link. Some have not always complied with their responsibilities. The GMC, as was pointed out, has indicated that it would like to do some tests on GPs who do out-of-hours work. It was clear from the Medical Act 1983 that the GMC could not carry out such tests, and it cannot do so under the directive which has been renewed but predates that. In 2004, therefore, the responsibility for ensuring that English was spoken was given to the PCTs. Most of them have delivered on that. Some have not, and that is what we need to change. The EU law will be reviewed in 2012, so the directive will be reviewed in any event. We must ensure that we examine the detail of that. However, we cannot wait until then. We must put in place safety checks to ensure that this year the lessons of that tragic death are learned and that Mr. Gray did not die in vain.