GPs' confusion over new out-of-hours service

Fears for patients are growing as doctors' surgeries say they are still in the dark about how a new out-of-hours service will work - less than three weeks before it is due to begin.

The new three-year contract, which will provide care at nights and weekends, comes into force on August 20 but has already been criticised by GPs who say it will lead to a degradation of the service.

And surgeries say they have still received no official notification of changes to the service and how they will affect both doctors and patients from either the Norfolk Primary Care Trust (PCT), which commissioned the service, or the East of England Ambulance Service (EEAS), which will operate it.

Dr Gordon Manson-Bahr, a GP in Long Stratton, said: “I've not had a letter from the primary care trust or the East of England Ambulance Service. Any information I have had has come from the EDP.”

Dr Peter Harvey, a GP in Holt, said: “I have not been told anything official about what's going to happen.

“I think that patients are going to have a very unstable experience. All you need is two or three people at once wanting to be seen in north Norfolk and what's going to happen? The pressure will be on the ambulance service and A&E.”

“It will put pressure on us, too. There will be more tendency to say 'Phone your GP in the morning' so we will pick up the pieces. Patients will be managed in a different way and I think it will be less appropriate.”

The manager of one Norfolk medical practice, who asked not to be named, said: “We've heard nothing. We should have been informed of what's happening if it's going to affect our patients and our services.”

The new contract, worth £5.2m, will cover all of Norfolk, except an area around Yarmouth. Under its terms, five out of seven emergency bases will no longer be staffed by doctors overnight.

Only the bases at Norwich and King's Lynn will be staffed after 11pm at weekends and bank holidays with the others replaced by five mobile units comprising either GPs or specially-trained paramedics known as emergency care practitioners (ECPs).

And during the week the Norwich, Lynn, North Walsham and Thetford centres will stay open until 11pm, backed up by three mobile units able to travel to patients where necessary.

A Norfolk family doctor, who asked to remain anonymous, said he was concerned that the ECPs did not have as broad a range of skills as GPs.

“They are good at specific emergencies but they have got a limited repertoire. They deal well with chest pain, cardiac emergencies, asthma and trauma.

“What they are not very experienced in are things like paediatrics, mental health, obstetrics and gynaecology. With the best will in the world they are not trained for everything.”

That meant they were likely to take some patients to hospital when they did not need to go, he added.

“If you fall into a grey area, say vague abdominal pain, they can't assess whether it's serious or not. There are gaps, and the only option the poor guys have got is to scoop and run.”

Norwich GP Dr Graham Clark said: “There are times when paramedics or nurses are the most appropriate people to see patients, but they are taking it to the next level, so much so that it almost becomes pointless having any doctors around.”

Dr Simon Lockett, secretary of Norfolk Local Medical Committee (LMC), was more optimistic. “The LMC is going to be involved in monitoring the new system to make sure it works,” he said.

“Obviously everybody's worried about change and things that might go wrong but there's no evidence of that yet. We're anxious not to shroud-wave or make people terrified when it might work perfectly well.”

The PCT referred all questions about the services to the East of England Ambulance Service, which said in a statement it was “delighted” to have been given the opportunity to continue the out-of-hours contract.

“We have written to our current workforce of around 300 GPs and they are able to view the shift patterns online. Feedback so far has been very positive.

“We will be making the best use of our resources by using a skill mix of doctors, nurses and emergency care practitioners (a highly skilled paramedic) to ensure that patients are treated by the right person in the right place.

“For example, it would be appropriate for minor injury or illness to be treated by a nurse or an emergency care practitioner, leaving our doctors available to deal with more serious conditions.

“Caring for patients is at the very heart of what we do and we do not anticipate that patients who have used the service before will experience any difference from the service they receive in future.”