Changes to the provision for out of hours primary care in England were a costly mess that allowed GPs to “run laughing all the way to the bank,” it has been claimed in a parliamentary inquiry.
MPs on the parliamentary Committee of Public Accounts, which held its inquiry into the provision of out of hours care in England last week, accused government witnesses giving evidence of allowing a change to how out of hours care is delivered that benefited only doctors.
The one-off evidence session for the inquiry was prompted by the publication earlier this month of a report by the government’s spending watchdog, the National Audit Office (BMJ 2006;332:1113, 13 May).
That report found that out of hours care in England cost £392m (€575m; $738m) last year, 22% higher than was anticipated by the government. It questioned the cost and quality of out of hours care since April 2004, when GPs could opt out of their 24 hour responsibility.
The committee’s chairman, Edward Leigh, the Conservative MP for Gainsborough, said: “We, the tax payers, are paying the price for a botched scheme costing £70m more [than was predicted], and very few PCTs [primary care trusts] can say they are meeting the policy requirements.”
In giving evidence Ian Carruthers, acting chief executive of the NHS, replied to a question about why out of hours provision had cost more than expected. He said, “One of the main driving factors was general practitioners’ salaries. They were set locally. They were variable.
“The other thing that many primary care trusts cited was the additional cost of the quality monitoring arrangements. It is clear from the report, however, that whilst the cost [of the scheme] was greater [than anticipated], there is much room for improvement, and already we are acting on that.
The previous arrangements for out of hours care were not sustainable, said Sir Ian. Now, however, the quality standards in place were more exacting than those previously outlined, and England’s system fared well when compared with elsewhere in the UK and internationally, he added.
Greg Clark, Conservative MP for Tunbridge Wells, said: “Isn’t it the case that the doctors, as a result of these negotiations, are laughing all the way to the bank and patients are suffering because they are not getting the treatment that they otherwise would have done?”
When asked directly whether the agreement on out of hours work was good value for money, Sir Ian said, “The answer is yes. It was good value for money in the context of negotiating the overall contract, because what that was designed to secure was better recruitment and retention and better working arrangements for doctors.”
David Colin-Thome, national clinical director for primary care at the Department of Health, also giving evidence, said, “At the time, in 2003, we had a particular problem in general practice.
“For the last 15 years we had had a big increase in hospital consultants and no increase in general practice, even though it is the biggest provider of clinical care in the health service. We had to recruit more GPs and get more rewards in, which is what the contract was about.”