Deal ends deadlock on GP night cover

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The threat of industrial action by family doctors was lifted yesterday after they struck a deal with the Government over out-of-hours cover.

The package is likely to see the development of more night-time primary care centres - either special centres or improved GP surgeries - with many more patients invited to travel to them for night and weekend calls, rather than the GP visiting the patient. Night visits will, however, remain.

The deal also ends the 24-hour individual responsibility for their patients that has been enshrined in GPs' contracts since the NHS was founded in 1948. In future, GPs will be able to hand the responsibility over for night and weekend cover to another, named and fully qualified, family doctor.

The deal - a compromise after 18 months of deadlock that was only resolved by the personal intervention in seven hours of negotiation of Stephen Dorrell, the Secretary of State for Health - was none the less hailed as "good news for patients and good news for doctors" by Dr Ian Bogle, chairman of the British Medical Association's family doctors' committee.

Patients would still be offered a consultation over the phone, or a home visit, but in time more patients would be seen "in properly equipped centres" by fully qualified GPs "rather than having the absurd situation of different doctors going round to people's homes", Dr Bogle said. Where primary care centres already exist, Dr Bogle said, they have proved popular. "Patients have been very satisfied with the arrangements."

A development fund of pounds 45m for this financial year - and, the GPs hope, more next year - will allow more such centres and surgeries to be developed, along with the purchase of better communication equipment. The cash can, however, also be used to improve commercial deputising services, in addition to the cover provided by GPs working in rotas or in doctors' co-operatives.

Although the individual doctor's 24-hour responsibility for patients has been ended, "the patient will know who is responsible for their out- of-hours care", Dr Bogle said. "The patient will have to know what the method is for contacting out-of-hours care and who the doctor is." If anything went wrong, the doctor responsible would be identifiable.

The ending of the 24-hour responsibility would mean patients were no longer faced with GPs having to work exhausted after being up half of the night. It might also lead to some family doctors specialising in night work.

Mr Dorrell said that with the issue settled, talks could begin on other matters affecting the GP service "allowing us to develop the jewel in the crown of the NHS, the family doctor service". The BMA's General Medical Services Committee accepted the package unanimously despite no extra cash being provided for this year to settle the dispute.

Under the settlement, the doctors' pay review body will price the cost of out-of-hours separately from the cost of day-time cover, and night- visit fees will be replaced by a payment of pounds 2,000 a year and a pounds 20 fee for each night consultation - whether in a centre or a patient's home. The Government will also launch a patient education campaign, aimed at reducing what doctors see as frivolous night calls to GPs.

Dr Bogle said despite his assurances that patients would not have suffered from the undisclosed sanctions that the GPs had planned, industrial action would have been good neither for them nor the patients. The settlement, he said, was "a victory for common sense".

His committee would continue exploring the possibility of creating separate contracts for night and day-time cover.

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