Medical Life

Ah, the good old days. Always bathed in the golden glow of selective hindsight. The scandal of out-of-hours GP care, exposed last week by the case of Daniel Ubani, the doctor who flew in from Germany and within 24 hours had killed a man, 70-year-old David Gray, with an injection of morphine 10 times the correct dose, has triggered rose-tinted memories of the past – and panicked promises to recreate it.

And no wonder. Nothing colours the public's perception of the NHS more darkly than a bad experience of emergency care. If your baby is running a temperature at 2am and screaming like he's fit to burst, you want a doctor and you want one now – preferably one who can speak the language and knows his lamotrigine from his laxative.

The Tory shadow health secretary, Andrew Lansley, said Labour had made a "serious error" by taking responsibility for out-of-hours care away from GPs, and pledged to restore it. He blames the 2004 contract when Primary Care Trusts took on the task of providing out-of-hours GP cover and private companies began flying in doctors from Europe and paying them up to £4,000 for a weekend shift.

The National Audit Office, which revealed the figures in 2006, found GP care at night was a shambles, with escalating costs, slow response times and a doubling in the number of doctors from Germany, France and Italy. The death of David Gray two years later at the incompetent hands of Dr Ubani was an accident waiting to happen.

Andrew Lansley thinks the answer is to put GPs back in charge and make them "collectively responsible" for providing out-of-hours care. He is tapping into a folk memory of general practice which has proved remarkably persistent, as portrayed by Dr Finlay of the much loved 1960s TV series Dr Finlay's Casebook, who was always there for his patients, day and night, with wise words or soothing tinctures.

That, alas, was a long time ago. GPs did once cover at night for their patients, sharing the task with colleagues or neighbouring practices. But during the 1970s, commercial deputising services grew up, staffed by young doctors moonlighting or between jobs, who progressively took on more of the out-of-hours burden.

By the 1990s, though GPs retained the formal responsibility, most switched the answering machine to the deputising service on a Friday night, went home and forgot about it till Monday morning. It was the same on weekday nights.

So how were things in this golden age? Andrew Lansley should ask Ann Abraham, the NHS Ombudsman. In July 2004 she described in her annual report a GP deputy who lied about his failure to diagnose appendicitis in a 15-year-old boy; another who tried to evade inquiries into how he missed a brain tumour in a female patient and a third who failed to start antibiotic treatment in a 32-year-old man with meningitis who later died. The quality of care, communication and record keeping was a "real cause for concern", she said.

The good old days? I don't think so.

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