Just half of GPs will work out of hours under new contracts, according to a survey questioning more than 1000 doctors. Published in Pulse magazine, the survey also says 62% of GPs believe patients will be less safe when primary care organisations take over night and weekend cover.
The new contracts are designed to halt the recruitment crisis in general practice and benefit the lives of family doctors. But, according to Pulse , GPs said using more nurses, pharmacists, and paramedics to aid the primary care organisations and reduce costs could "compromise patient care."
Deputy chairman of the BMA's General Practitioner Committee, Dr Hamish Meldrum, told the BMJ : "There's an argument for no one seeing anyone but a GP—if they had an ingrown toenail, they could see their GP because they might have septicaemia. We haven't got enough doctors for this. It's an inappropriate use of highly trained professionals. Nurses are used in the daytime in my GP surgery so why not out of hours?"
Under the new contracts, GPs will be able to hand over liability for out of hours care to primary care trusts. Doctors who do so will forfeit £6000 a year from their earnings, with the cash going to trusts to spend on locums and cover staff.
More than a third of the GPs surveyed thought that the changes would encourage patients to use the NHS less responsibly, with more patients visiting their local accident and emergency departments, and 92% of the doctors felt the changes would mean extra work on Monday mornings.
There were also concerns raised about primary care trusts providing cover in more rural areas. Dr Meldrum said, "We need to make sure the standard of primary care trusts arranging this cover is adequate. We've always recognised there may be one or two isolated instances when GPs can't choose to stop out of hours work, but these cases will be unusual."
As a negotiator on the contracts, Dr Laurence Buckman told the BMJ he was "not surprised" that so many GPs would decide not to work out of hours. "I think many GPs are called out all the time. Pharmacists provide a very good first line for primary care for most patients who have minor, self limiting illnesses with distressing symptoms. And pharmacists want to do this work, with remuneration, of course."
Dr Meldrum said, "I'm not sure how scientific the Pulse survey was "we don't see the whole thing as a seismic shift. There has been a problem trying to get GPs to work out of hours. This is not good for patients or doctors." He added, "This move will see patients getting the best care and GPs having the rest and relaxation they deserve."