Skip to main content

Out-of-Hours Primary Care

Volume 492: debated on Tuesday 12 May 2009

3. What assessment he has made of the standard of out-of-hours primary care in (a) Solihull constituency and (b) England; and if he will make a statement. (274100)

The independent regulator, the Healthcare Commission, recently reviewed urgent and emergency care in England. Solihull was given a rating of three—five being the highest and one the lowest—with out-of-hours services contributing to 25 per cent. of that score. The review found that, nationally, out-of-hours services had improved significantly since 2005. Where the local NHS has concerns about the performance of its out-of-hours providers, it must take urgent and robust action to address them.

Following the death of Mr. David Gray at the hands of Dr. Daniel Ubani, is it not the case that the Minister cannot give me an assurance for my constituents in Solihull, or indeed for constituents anywhere else, because there is no mechanism for assuring the quality and consistency of out-of-hours service? Do not patients need some guarantee on what basic level of assistance they are likely to receive?

The hon. Lady is wrong; the quality of out-of-hours services is monitored and assured in a number of ways: first, primary care trusts have clear legal responsibilities to provide safe, high-quality out-of-hours services; and, secondly, strategic health authorities act as performance managers. The regulators, as she will be aware, are now investigating the provider that ran the services that led to the tragic death of David Gray. I would like to update the House. East of England strategic health authority informed me this morning that it had discovered new issues of concern about Take Care Now—the provider of the services in the case in question—and its performance that predate the Dr. Ubani case. The SHA is now reviewing, with the PCTs concerned, its previous decision to continue to use TCN services, pending the outcome of the Care Quality Commission investigation.

Both the National Audit Office and the Public Accounts Committee have, for some time, pointed to significant flaws in the private provision of out-of-hours general practitioner care. As the hon. Member for Solihull (Lorely Burt) said, there have been fatal shortcomings in outsourcing an essential aspect of primary care. Does the Minister agree that more and more PCTs across the country should follow the example of Leicestershire County and Rutland primary care trust, and bring outsourced out-of-hours provision back in-house? Failing that, should not the performance of organisations be tracked much more closely by the Department of Health, so that our constituents are not left to the mercies of cowboy clinicians?

Decisions such as that taken by my hon. Friend’s PCT are for local primary care trusts. I have to challenge him on his interpretation of the National Audit Office findings and the Healthcare Commission’s findings. The NAO report did not find any evidence of risk to patient safety in out-of-hours services, and it showed that eight out of 10 patients were satisfied. As I have said, the Healthcare Commission report found significant improvements in performance since 2005. Neither of the reports found that there was variable performance between private and non-private providers.

The vetting procedures referred to by the Minister must be hopelessly inadequate to allow a cosmetic surgeon from Europe who did not even know the correct dose of diamorphine to work in this country. He has admitted killing the patient with a dose 10 times too great. Whatever vetting procedures we have are inadequate, and I ask the Minister to take steps to improve them, particularly in relation to doctors coming from the European Community.

As a doctor himself, the hon. Gentleman will know that this country has among the highest levels of vetting of professionals of any country in the world. Employers have a legal duty to ensure that all doctors whom they appoint are fit to practise, and all doctors, including locums, must be on an official performers list, and must be registered with the independent regulatory body, the General Medical Council. He is right: we are talking about an absolutely terrible case, for which the doctor has been tried in his absence. As a result, as I informed the House, the SHA, with local primary care trusts, is reviewing the contract given to the company concerned. There are clear legal obligations on PCTs and strategic health authorities to ensure that their out-of-hours services are safe. Something went terribly wrong in the case that we are discussing, and he is right that it is important that both the local and national NHS learns the lessons as a result of it.

But is it not elementary that the best out-of-hours services are provided by doctors who know their patients and their records? Should we not have a concerted campaign to try to ensure that, wherever practicable, out-of-hours services are conducted by family practitioners who normally look after those patients?

The hon. Gentleman makes a very good point. The vast majority of out-of-hours services up and down the country are still provided by local GPs, whether working in co-operatives or social enterprises, or for private organisations that are contracted or commissioned by the primary care trust. The difference between the system now and the previous system is that they are not compelled to do so. The problem with the previous system was that GPs often felt overtired: mistakes were made and the service was patchy and dangerous in many places. The Conservative idea of going back to the bad old days of forcing all GPs to provide out-of-hours-services would be an absolute disaster.

Following the question from the hon. Member for Wyre Forest (Dr. Taylor), Medical News Today reports that

“some…EU-qualified doctors acquired their rights to practise without any specific training in general practice.”

However, they could end up—and have ended up—working in our out-of-hours services. While it is not possible to prevent such doctors from practising in this country, it is possible to stop them being employed in NHS out-of-hours services. Is it not time that the Minister ended that practice and made it an absolute requirement on out-of-hours providers that they cannot employ anyone without the training required for British-trained GPs, as well as for those GPs who come from outside the EU.

Without repeating what I have said about the legal duties of the commissioners of the service and employers to verify whether someone is fit to practise, and about the role of the GMC, I am sure that all those organisations, including the GMC, will be very interested in the article that the hon. Gentleman has just produced.

May I press the Minister a little further? I do not wish to repeat what has already been said, but it is quite clear that the Government mismanaged the negotiations on the 2004 GP contract resulting, whatever the Minister says, in an out-of-hours service that is at best fragmented and inconsistent. As we have heard, the tragic death of David Gray in Cambridgeshire starkly highlighted the inconsistencies and variations in primary care trusts’ registration of locums, as well as the lack of co-ordinated quality in patient safety standards. That needs to be addressed urgently. Does the Minister agree that that demonstrates that GPs are closest to their patients and the communities they serve, and are therefore in a significantly better position to commission out-of-hours care on their patients’ behalf, without necessarily having to provide it themselves?

It is only since 2004 that we have had a framework that is supposed to deliver a uniform service across the country. People behave and talk as if there was some golden age in which there was a wonderful out-of-hours service, but it did not exist. Some parts of the country did not have a service at all; in other parts, the service was dangerous or patchy. Doctors resented being forced to do that work, and we had massive recruitment problems, particularly for women doctors. Doctors were often overtired, and there were serious accidents. We now have a system in place with a legal responsibility on the commissioners at local level—the PCTs—to deliver a quality service for their population. They are overseen by the regional level of the NHS and by the independent regulator, who did not exist before. We therefore believe that we have the right systems in place—it is the implementation of those systems that we need to ensure is right, and as the independent Healthcare Commission itself says, the quality of out-of-hours services has improved significantly since 2005.