Out-of-hours GP services 'lamentable'

Case of patient given fatal morphine overdose prompts coroner's outburst

A coroner criticised Britain's "lamentable" out-of-hours GP services yesterday after concluding that a patient given a fatal overdose of morphine by a locum doctor from overseas was unlawfully killed.

David Gray, 70, died after he was injected with 100mg of diamorphine – 10 times the recommended daily dose – at his home in Manea, Cambridgeshire, on 16 February 2008. His partner had called the out-of-hours service because Mr Gray was suffering from renal colic but the doctor who attended him, Daniel Ubani, who had arrived from Germany the day before, spoke little English, was tired and had never used morphine before.

Concluding a 10-day inquest into Mr Gray's death, Cambridgeshire North and East coroner, William Morris, delivered a savage indictment of the doctor and of the system which had allowed him to practice in Britain.

"How was it that a doctor, who did not obtain his qualifications in this country, whose first language was not English, who was probably fatigued, who received a less than adequate induction and who was unfamiliar with the NHS system, and who did not know the area, came to be treating patients in Cambridgeshire, and treating at least some of them incompetently? How was this lamentable situation reached?", Mr Morris said.

Dr Ubani was "incompetent and not of an acceptable standard" and Mr Gray's death in 2008 amounted to manslaughter as a result of gross negligence, he said.

Mr Morris called on health ministers to set up a national database of overseas doctors wanting to work in the UK, review the way European Union rules allowing doctors to work in member states operated in the UK and ensure that doctors had "sufficient" knowledge of English.

Mr Gray's son Stuart, himself a GP, echoed the coroner's criticisms and called for Dr Ubani to face justice in a UK court. Dr Ubani was charged in the German courts over the case and given a nine-month suspended sentence and a fine of €5,000 (£4,370), which means he cannot be charged in the UK courts.

Mr Gray said: "Every doctor used for out-of-hours care should be properly trained for the job and every one should be able to speak English – common sense requirements which Dr Ubani failed to meet."

His lawyer, Inez Brown, said doctors from Europe were subject to "less stringent checks than doctors anywhere else in the world" and it had taken Mr Gray's death to highlight it.

The General Medical Council said the "avoidable" tragedy had happened at least in part because doctors from the EU coming to work in the UK cannot be required to take a language test.

But the Department of Health said there was a duty on Primary Care Trusts to check that doctors they hired were fit to work, including checking on their ability to speak English, which was independent of the duties of the GMC.

A review of out-of-hours services by the Government's primary care czar, David Colin-Thome, commissioned by the Department of Health and published after the coroner's verdict, concluded there were "unacceptable" variations in standards of care around the country.

"We discovered that most providers did not make an assessment of the clinical skills or competence of their clinical staff," the report said.

Accepting all 24 of the reports recommendations, Mike O'Brien, health minister, announced stronger national minimum standards and a new model contract for out-of-hours services.

Mr O'Brien said: "I extend my condolences to the family of Mr Gray. Patient safety must be a top priority of the NHS. Although out-of-hours services are much better than before 2004, some PCTs are not meeting their legal obligations and I am determined to tackle this."

Until 2004, GPs covered out-of-hours at evenings and weekends, by working in rotas or hiring commercial deputising services. From 2004, most GPs opted out of out-of-hours responsibility under a deal negotiated with the Government and PCTs took over running of the service. The Tories have promised to review out-of-hours care if they win the next election.

Shadow Health Secretary, Andrew Lansley, said Labour had made a "serious error" by taking responsibility for out-of-hours care away from GPs.