Bidding war fears for GPs' out-of-hours service

MARK NICHOLLS The out-of-hours GP service across Norfolk and Waveney faces a looming crisis amid fears that a fierce bidding war over the new contract will see cutbacks.


The out-of-hours GP service across Norfolk and Waveney faces a looming crisis amid fears that a fierce bidding war over the new contract will see cutbacks.

The key funder Norfolk Primary Care Trust is demanding a cheaper deal as it battles to slash a multi-million pound deficit, sparking concerns that the quality of the current service could be affected.

With less cash to pay GPs, doctors could be less willing to provide cover at nights or weekends if their pay was reduced. There were also warnings that patient welfare would be affected with delays in responding to their needs.

Anglian Medical Care, which is part of the East of England Ambulance Service, runs the current operation but is gearing up for a tough fight to hold onto the contract as rival bidders line up to offer cover for Norfolk and Waveney.

Last night, Dr Nick Morton, Assistant Medical Director of the East of England Ambulance Service, said: “We face stiff competition to maintain the contract, which expires this summer, but we are very hopeful of doing so and building on the trust and support we enjoy from the region's GPs.”

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But he added: “In terms of finance we are always looking to do things more efficiently and believe that we can, but it almost goes without saying that if there were to be significant financial cuts then the quality of service would suffer.”

With Norfolk PCT £50m in the red and already looking at would-be suitors for a more cost-effective contract, North Norfolk MP Norman Lamb is concerned that a new contractor will offset a cut-price bid with a reduced service.

In other parts of the eastern region some contractors are believed to provide the out-of-hours provision costed on a figure of £5-6 a head of population whereas AMC works on £9 a head.

The MP, who is the Liberal Democrat health spokesman, said: “There is no suggestion that the out-of-hours service in Norfolk is wasteful, by and large it seems to work well. But it looks as though we are going to be talking about a 30-40pc cut in expenditure.

“The point was made to me by a GP that it could mean a matter of life and death. We are may be talking about a level of service that puts patients at risk.

“We also have to remember that counties such as Essex are different to Norfolk. It costs more to provide this service in a remote rural community than in built-up areas and one with an elderly rural population.”

AMC says that it runs the service with around 90pc of home-grown GPs, making the remainder of shifts up with agency doctors which can occasionally mean medics coming over from Europe to fill shifts that can pay £50-£80.

However, sources indicate that elsewhere in the east, GPs are only being paid £40 a shift and the new contractor may want to introduce that salary level into Norfolk.

With GPs currently earning about £100,000 a year under the new GP contract, with no obligation to work OOH shifts, such a pay cut may make the idea volunteering for night and weekend cover less attractive to family doctors.

This could result in a greater reliance on nurses to provide OOH cover or GPs shipped in from Europe for shifts such as the case of the Italian doctor flown in over Christmas to a remote part of Scotland and paid £3,200 for five days work.

It also coincides with reports of an expected shortfall in GPs over the next few years.

GP representatives met with AMC this week and are planning to meet Mr Lamb and the PCT over the OOH issue.

Norfolk PCT concedes it is looking for a better value option for its OOH operation.

The PCT's director of clinical services Dr Rob Colebrook said: “When we made comparisons with OOH services in other parts of the country, in terms of value for money, our service is expensive.

“We need to make the most of tax-payers money and have revised our service specification to bring it in line with similar services elsewhere. We are involving our patient representatives and stakeholders, such as local authorities and other NHS organisations, in the process.”

Simon Lockett, secretary of the Norfolk Local Medical Committee which represents GPs, said: “From our point of view, we are anxious that patients continue to get the excellent out-of-hours service they are getting at the moment.

“It has become clear that if they do not, they will get ill when they should not have done, or if treatment is postponed it will mean that things will get even more pressured for GPs during the day and we will not be able to give patients the care that we can now.”

He suggested that if payments to GPs are cut, some local doctors who man OOH shifts may review their position.

“This appears to be nothing other than a cost cutting exercise in which our patients will suffer,” added Dr Lockett.