The Out of Hours Care Report

The last week has been very busy, both politically at a national level and locally in my surgery, but most of my time has however been focused on the issue of the performers‘ list and Out of Hours provision, following the inquest into the tragic case of Mr Gray. The Coroner was very clear in delivering a verdict of unlawful killing on the Out of Hours doctor Daniel Ubani. This whole case has upset me greatly, and clearly this was an appalling tragedy. I do feel for Mr Gray’s family, and I admire how Stuart Gray, his son and West Midlands GP, has handled himself throughout what must be a really difficult time.

The independent review that I carried out with the Primary Care Tsar Dr David Colin Thomé was published immediately after the inquest. The Minister, Mike O’Brien, David and I were immersed in news and television interviews for most of the day. Most went reasonably well but Jeremy Vine, and then Edwina Currie had a go at me – ‘the good professor’. They seemed to think that we should go back to pre-2004 – complete nonsense. They don’t understand.

It seemed like they were putting all the blame on GPs – you and me – or the GP contract. I tried very hard to say that the contract was needed and how I had spent five or six years working every other night and every other weekend, being exhausted and having to go out and visit people – many of whom didn’t need visiting – children with runny noses and sore ears in the middle of the night. I can even remember visiting an old woman with a chest infection one Christmas to find a GP from another practice in the same bedroom visiting her husband who also had a chest infection!

I tried to point out that the awful case in Cambridgeshire has nothing to do with the contract and that the whole point of moving commissioning to PCTs was that better quality care could be provided across a locality by GPs who are alert and not exhausted both in and out of hours. They completely missed the point, but most of the other media thankfully took a more sensible view.

We conclude in our report that the quality of OOH provision varies across the UK, and made twenty-four recommendations, which include:

• PCTs should review the performance management arrangements in place for their out-of-hours services and ensure they are robust and fit for purpose;
• The Department of Health should issue guidance to PCTs to assist them in making decisions about whether or not a doctor has the necessary knowledge of English;
• The Department of Health should develop and introduce an improvement programme for PCTs to support their commissioning and performance management of out-of-hours services;
• Out-of-hours providers should consider the recruitment and selection processes in place for clinical staff to ensure they are robust and that they are following best practice;
• Strategic Health Authorities should consider how they monitor action taken by PCTs in response to this report and in carrying out appropriate performance management of out-of-hours providers; and
• Providers should co-operate with other local and regional providers (both in and out-of-hours) to share any concerns over staff working excessive hours for their respective services.

The report can be found here

I hope you will have a chance to read the report in full and would be very interested in your feedback – especially as I have to give evidence on the issue to a Parliamentary Select Committee in early March, which is a stressful experience in itself.

I know that all of us GPs want to provide the best quality care for our patients. It’s a real shame that people feel that because of this case we’ve all let our patients down. I hope that some good can come out of this and that we can improve the system to ensure that patients get the care they deserve, night and day, regardless of where they live.

Thanks as always for your support. I value your opinions and feedback enormously, and I urge you to get in touch if you have any comments or questions for me.

New Year

Photograph of Cannon Hill Park © Birmingham Mail

Let me start by wishing you all a very Happy, Healthy and Prosperous New Year. 2010 is already proving to be enormously busy; time has been spent between concentrating on plans for extended GP training, and editing academic papers. I’ve also been spending more time at Bellevue, and have done a number of extra surgeries, due to one of my partners being unwell.

It has been so rewarding to spend more time in the surgery with my friends. In the snow, even Birmingham looked attractive… and having negotiated the ice-rink we used to call the car park, it was great to get into the heat of the surgery.  I had expected that many people would be kept away due to the snow, slush and freezing fog. This proved not to be the case, and already this year I’ve seen a number of seriously ill people presenting complex physical and psychological issues. I really enjoy being in practice and seeing patients; I believe it is so important to keep grounded in surgery, and I feel privileged to work in the busy, inner-city General Practice that is Bellevue Medical Centre.

I received a letter a few weeks ago asking me whether, if offered, I would accept a CBE. I gave it some serious thought and, as many of you may have seen in the press this week, was delighted to accept. My enormous pride and gratitude outweighs the slight embarrassment I am feeling as a result of the attention, and I am very much looking forward the forthcoming trip, taking my family to Buckingham Palace. My mum and dad are really happy, too.

This award is a huge honour, and it’s wonderful to be able to thank to my colleagues; at Bellevue, those I’ve worked with in post graduate medical education, and at the RCGP, my family and the many friends I have made over the years. It is testament to the wealth of advice, encouragement and support I have received throughout my career and it’s a great start to the New Year.

As you know, towards the end of last year I was heavily involved with publicising the scandalous treatment of immigrant children and families in detention centres. The work of the College, and a number of other organisations, has led to this issue garnering extensive media coverage. The campaign seems to be really hitting home, and lends hope that this shambolic and disgraceful practice can be brought to an end as soon as possible.

My focus into the New Year has remained on the welfare of children and vulnerable people: I have expressed my concern at the worrying internet strangling craze that a number of young people have embraced. This disturbing, highly dangerous, risky practice should be avoided at all costs, and parents and GPs need to be aware of it.

I have also spoken out against product placement on television. I am particularly worried about the placement of alcohol and unhealthy foods, not just for children – who can be easily led by advertisements – but also for adults. I think that the argument that products will only be placed in programmes that are not viewed by children – such as Coronation Street and Emmerdale – is disingenuous; the role modelling on sitcoms and soaps is so important; we must protect young people from harmful influences and not fuel the obesity epidemic.

As always, I value your opinions and feedback enormously, and I urge you to get in touch if you have any comments or questions for me.