Health chiefs warning over out of ours doctors

Sarah HallOnly doctors familiar with local health services should provide out of hours primary care, according to two regional health experts.Dr Paul Cosford, the director of public health for NHS East of England and Dr Justyn Thomas from NHS East of England's public health and social care directorate, spoke out following the death of a 70-year-old patient who was given a fatal overdose of diamorphine by an out of hours doctor.Sarah Hall

Only doctors familiar with local health services should provide out of hours primary care, according to two regional health experts.

Dr Paul Cosford, the director of public health for NHS East of England and Dr Justyn Thomas from NHS East of England's public health and social care directorate, spoke out following the death of a 70-year-old patient who was given a fatal overdose of diamorphine by an out of hours doctor.

Dr Daniel Ubani, 67, injected David Gray, of Manea, Cambridgeshire, with 10 times the recommended dosage of the drug on February 16, 2008.

He was a locum doctor from Germany employed by Take Care Now (TCN) and he gave the overdose on his first shift with the company after he had just arrived in the country.


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In a paper published in the British Medical Journal (bmj.com) today they argue only doctors who know how local health services run should be able to provide care in the evenings and at weekends.

The authors said: 'Dr Ubani had never worked in the United Kingdom, did not practice primary care in Germany, and was not familiar with local health care or with diamorphine.

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'Yet he could fly in on Friday evening and work unsupervised on Saturday without routine access to patient notes.'

They said Dr Ubani made a critical and fatal error but they believe that solely to blame him is to miss several key facts and that a wider examination of the system that allowed him to practise in these circumstances is needed.

They point out that many areas do have high quality out of hours care, but point to other contributing factors in this case and recommend areas for change.

These include a review of laws governing registration of doctors from the European Economic Area. 'This is not to prevent the free movement of well qualified doctors,' they explain, 'but to recognise that healthcare systems differ across the EU, and that doctors' competence is at least partly specific to the system in which they work.'

They also strongly advocate changes to the primary care trust performers list system - currently a doctor on one list can practice anywhere in England, but this system should require GPs to be on the list of the trust where they work, with the extra provision that GPs should be able to enter more than one list if they have good reason.

'As a profession, we should not accept a system that allows incidents such as this in any part of the NHS,' they conclude. 'Clinical leaders throughout the NHS must advocate and lead the necessary changes."

Last week a panel from the General Medical Council (GMC) has ruled that Dr Ubani should be banned from ever practising medicine again in the UK.

He was given a suspended sentence in Germany for death by negligence but was still able to practise there as GMC powers do not extend to other countries.

On Saturday his two grieving sons were arrested at a German medical conference after confronting Dr Ubani. Stuart and Rory Gray disrupted a speech given by the doctor about cosmetic surgery and asked how he could continue practising in Germany when he was banned in Britain.

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