999 warning over GP out-of-hours cuts

Paramedic crews responding to emergency 999 calls could be put under serious strain by cuts to the GP out-of-hours service, a patients' watchdog warned last night .

Paramedic crews responding to emergency 999 calls could be put under serious strain by cuts to the GP out-of-hours service, a patients' watchdog warned last night.

The cash-strapped Norfolk Primary Care Trust is looking for a cheaper version of the current weekend and overnight cover for GPs and has invited companies to bid to run the service over the next three years.

Patient campaigners are now concerned that will mean a cut in the out-of-hours provision - leading people to dial 999 instead of trying to reach an on-call doctor.

The issue was raised yesterday at the Norfolk health overview and scrutiny committee as PCT chiefs were quizzed over future plans for the service - currently run by the East of England Ambulance Service's Anglian Medical Care (AMC) organisation.

David Russell, from the patient and public involvement forum for the ambulance trust, said: “What we are concerned about is the effect the changes may have on the ambulance service locally. If patients cannot get to see someone, they will dial 999 and that will take up the services of an emergency ambulance.

“Any significant change to the out-of-hours service or reduction in bases will have a significant effect on patients, particularly those who do not have their own transport or are too ill to drive. What we want to see maintained is a quality service that is targeted and tailored to patients.”

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The concern comes after it emerged that nationally 999 calls to ambulance services are soaring, reaching a 10-year high of nearly six million in England during 2005-06. In the eastern region, 999 responses rose by more than 8pc.

The PCT, currently £47m in the red, is seeking tenders from companies to run the service in Norfolk from August. It was launched in 2004 by AMC, which is hoping to retain the contract.

The PCT has changed the specification for the service and is also looking at reducing the number of operational bases, particularly those close to the county border that do not have 360 degree coverage.

But it is also considering establishing out-of-hours (OOH) bases close to A&E departments at the Queen Elizabeth Hospital in King's Lynn and the Norfolk and Norwich University Hospital.

Councillor Tony Wright told the committee he had heard of examples where people were going to A&E because they were not able to contact anyone through the OOH service.

The competition for the new contract is likely to be more fiercely fought over than it was three years ago.

Mandy Hall, who is leading the PCT's reorganisation of OOH, said: “In 2004 when the GP service first started, there were only two organisations that were able to provide a service like this. Today there are 15. There is also a Department of Health directive that PCTs should go for a better value for money service than they originally did so.

“A particular change is that there was a 20-minute travel time to a base for patients. That is now going to be a 30-minute travel time.”

Staffing on some shifts, particularly those from midnight to 6am, would change with only four doctors on duty across Norfolk during some periods because of reduced demand, said Ms Hall, who added that in the main patients would see little change.

“We do want a quality service, she said, “and those quality requirements are much more rigorous than they were in 2004. Rather than a yearly review of our of hours service, that now happens monthly.”

The service is currently manned by GPs working shifts at between £50 and £80 an hour. It currently works out at £9 per head of population in Norfolk to operate but the PCT is reported to be looking for a service that costs closer to £5 a head.

GPs in Norfolk have already warned that the changes could put patients at risk.

The ambulance trust is bidding to retain the contract but with a range of competitors vying to undercut it, ambulance bosses recognises it will have to be “astute” in the way it positions its bid.

Ambulance service chief operating officer for Norfolk, Lyn Reynolds, said: “We hope to be the new provider and we are the only provider able to offer the same level of integration in the service as at present.

“There has been a rise in 999 calls but we do have a system where we can triage inappropriate calls and alleviate pressure on A&E.”

Andrew Stronach for the N&N said that the hospital's A&E department had experienced an increased workload since the OOH system came into effect in 2004 and would be concerned if any more changes saw that workload rise further.

He said: “The idea of co-locating an out-of-hours service at A&E was looked at 2-3 years ago. There are practicalities about where it would be sited but if it is back on the agenda, it is something we would be happy to look at again.”