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Out-of-hours service "poor"

Foreign doctors need more training and the out-of-hours GP system is inadequate, according to a government-ordered report.

GPs from other countries should prove they have the required skills and knowledge to work for the NHS, and be proficient English speakers, it recommended.

Some primary care trusts (PCTs) let their out-of-hours service suffer due to poor contract management and insufficient resources to monitor GP and private-company performances.

The report made 24 recommendations for improvement, which the government is expected to accept before ordering PCTs to quickly comply.

Study leaders David Colin-Thome, Clinical Director for Primary Care at the Department of Health, and Steve Field, Chairman of the Royal College of GPs, found the out-of-hours service is badly integrated with other urgent departments such as A&E.

It is expected that the government will say some PCTs fail to meet safe care obligations, and instruct them to inform the General Medical Council whenever they refuse to hire a doctor, so a different trust does not unknowingly take on the same GP.

Copyright © Press Association 2010

Department of Health

Your comments (terms and conditions apply):

"I work in an OOH service and cannot relate to the previous comments. The service I work for provides a high-quality service responsive to patient needs. We comply with NQRs and our staff are vetted pre-employment and are regularly audited on performance. The recent negative comments towards a few OOH providers have tarred us all with the same brush, unfortunately" - Alison Chadbiund, Walsall

"I work in the OOH service as a nurse practitioner, and it is one of the most unpleasant places I have ever worked. There is a constant shortage of staff, whether nursing or medical, and the pressures are so great that it is worse than I experienced in busy urban A&E depts and short-staffed wards. Nurses (whether practitioners or not) are expected and pressured to deal with things that are really above our competency and experience. We have occasionally had doctors that we have despaired of, but generally the salaried and regular GPs are excellent. During the swine flu rush for Tamiflu we were left with agency nurses to help with the phones as we were generally unable to cope with the pressure, and these nurses were also expected to work in consulting rooms. All but one of them were hopelessly out of their comfort zone. However, the public and the government have to take their share of the responsibility. Successive governments have constantly given the impression that the public can have anything they want, at any time of the day or night, however minimal. And the public do exercise this right, looking for the miracle cure or 'magic pill' that will get rid of the virus that they have usually seen their own GP for previous to their attendance" - Name and address supplied

"British nurses have to provide evidence that they are up to date and have the skills and knowledge to practice in whichever department they are in. It is an 'insult' to the profession to have poor speakers of the language with archaic practices to be able to work in the Out of Hours Service, the insult is made worse by the large salaries these foreign doctors can earn often much more than in their own country as well as their expenses such as hotel bills etc. I have worked in an Out of Hours Dept where this has happened. There were also newly qualified doctors also who, in spite of a long training, still did not have the experience to take on such a role. If it had not been for the support of experienced nurses I am sure there would have been a lot more 'mistakes' made. It seems ludicrous that a signature on a prescription in the form of a rubber stamp or guess work which happens! Thank heavens for nurse practitioners but there are not enough jobs for them! Many doctors fear that they could be a cheaper replacement which is true, but not if they are put in place of 'qualified inadequacy!'" - Jacqueline Habgood-Painter, Dorset

"The current National Quality Requirements for OOHs are being so badly interpreted when it comes to standards 4 and 5 and the variance as to how they are implemented is huge. Most do not know what they should be doing, some aren't doing them at all amazingly and most do them in a way that suits them. The DoH have not provided enough information to providers on how to monitor their staff, hence the confusion. We need more robust quality assurance that cannot be misinterpreted and that PCTs fully understand and do not leave up to the provider to decide what they will do" - Sally-Anne Pygall, Durham