Family doctors to be freed from round-the-clock duty to patients

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The 24-hour-a-day responsibility of family doctors for their patients will be abolished in a planned radical overhaul of their contracts.

Under an agreement between the British Medical Association (BMA) and the Government, doctors would be freed from their historic duty to be on call round the clock.

Responsibility for the care of people who become ill in the evenings, at weekends and on bank holidays would pass to designated on-call doctors and clinics. Doctors would also be given more control over their workload and extra incentives to raise the quality of the care received by patients under the new contracts. In addition they would be able to opt out of offering some services, such as providing repeat prescriptions and vaccinations.

The proposals follow a long-running dispute between the BMA and the Department of Health over moves to change GPs' contracts. In a ballot last year, more than half of Britain's doctors threatened to quit the NHS unless their workloads were reduced.

Yesterday's moves reflect the Government's desire to remove the threat of industrial action as it embarks on reform of the NHS. Alan Milburn, the Secretary of State for Health, has said he aims to recruit 15,000 more consultants and doctors over the next six years.

John Chisholm, chairman of the BMA's general practitioners' committee, said: "We believe this new contract is vital to help Alan Milburn deliver that target. Unless we see a new contract that's good news for patients and good news for family doctors, we are going to see an exacerbation of the dire workforce problems we have in general practice."

He said there was a "dire shortage" of family doctors as GPs retired early and potential new recruits were deterred because of the work pressures they faced. Only 18 extra GPs had been recruited last year, compared with the Government target of 500, he said.

"The current situation simply cannot go on. The new contract framework allows GPs to control their workload. But patients can be assured that when they are ill, they will be treated."

Dr Chisholm said that the 24-hour, 365-day responsibility for patients had been a severe disincentive to recruitment and retention of GPs. He stressed that patients would still receive out-of-hours care even though the responsibility for providing this service would in most cases pass to the local primary care organisation.

"It gives GPs the power to use resources as they see fit in the interests of patients and in the interests of the health service," he said.

In other proposals, GPs will be allowed to work as salaried doctors or to become self- employed, and they will receive seniority payments to reflect experience. The contract includes a commitment to shake up the allocation of resources to GPs' practices and provide modern primary care premises.

Over the next two months, the BMA and the Department of Health will negotiate over the financial settlement underpinning the contracts. The BMA plan to put the proposals to a ballot of members in the summer, with the hope that the changes, some of which will require parliamentary legislation, will be phased in by 2004.

A spokeswoman for the Department of Heath commented: "We welcome the contract framework agreement. Primary care is a fundamental part of the Government's ambition to reform the NHS and the new contract for GPs is going to be a crucial part of that process."

She added: "It better rewards general practitioners for their commitment and hard work, and crucially the rewards themselves will reflect improvements in quality of care for patients."