Out-of-hours services, which provide cover when GPs are not working, are finding it so hard to do so that in some cases they have increased the rates of pay they offer by 40 per cent in a year.

Some doctors predict that the cost will rise further next year when GPs are able to opt out of providing out-of-hours cover, and that the cost will have to be met by Primary Care Trusts, which regulate local health services.

Latest figures reveal that doctors in Surrey are being offered pro-rata rates of £140,000 a year, an increase of 40 per cent on last year’s rates of pay. Another out-of-hours service in Cleveland said that it was offering one GP £120,000 a year, and another in Harrow had increased its rates by £6,000.

The Surrey out-of-hours co-operative Thamesdoc told the medical magazine Pulse that it was increasing its rates by 40 per cent. It now pays £100 an hour on Bank Holidays, £65 an hour at weekends and £50 an hour for shifts during the week. The West London cooperative Harmoni said that it was increasing its rates by £6,000 to £110,000 a year.

“We will all have to take into account the going rate to get GPs to work out-of-hours,” David Lloyd, external relations director for Harmoni and a GP in Harrow, said.

From December next year GPs will not have to work out-of-hours unless they wish to, and the responsibility for providing cover will pass to the trusts. Some doctors fear that this will increase the costs of out-of-hours cover yet further as more doctors opt out of the system and the trust has to pick up the bill.

GPs gained the right to opt out in negotiations this year with the Government over contracts. Much out-of-hours cover is provided at present by co-operatives of GPs, who combine to cover a number of practices. Anecdotal evidence suggests that some GPs are planning to opt out of normal hours altogether because they can now make more as a locum without the responsibility of running their own surgeries.

Richard Evans, a GP in Woking, Surrey, who works three shifts a week for Thamesdoc, said that he would not give up on his regular practice but that the pay increase would help him to retire at the age of 60.

“If there is a choice I will choose weekend sessions now as they pay more,” he told Pulse. “It is a lot more than I get as a GP.”

Tony Welch, a GP also working in Surrey, said: “The big worry is that when trusts take over the cost of providing out-of-hours cover they will not have the money to pay for it. It appears you have to pay ever more money to attract people.”

The British Medical Association said that the increases were largely owing to supply and demand. “I would say the old GP contract was responsible for undervaluing out-of-hours work,” Hamish Meldrum, of the BMA’s GP committee, said. “What we are seeing are market forces.

“While GPs may be earning £100 on Bank Holidays, I would say the normal going rate for weekends is more like £45 an hour. While that may seem a lot, it is similar to calling out other professions during anti-social hours.”

A spokesman for East Elmbridge trust said that it was concerned about the prospect of increasing wage demands. “We do not want to see the prices rocket,” she said. “We are already subsidising out-of-hours quite heavily.”

The problem is being made worse by the national shortage of GPs. Many have become disillusioned by long hours and poor conditions of service and have taken early retirement. The Government has countered this by agreeing to the new national contract and starting a recruitment drive. However, there is a gap of at least seven years between attracting candidates and them starting work.

• Almost 80,000 people contacted the NHS careers helpline after a £3.3 million recruitment campaign, the Department of Health said yesterday.

  The “Join the team, make a difference” drive in February, which used television and newspaper advertising, aimed to draw new recruits and attract trained staff back to the NHS.

  John Hutton, the Health Minister, said the response showed that the NHS was an attractive place to work. “There are now almost 50,000 more nurses, almost 8,000 doctors and over 8,000 therapists working in the NHS than five years ago.”

  Liam Fox, the Shadow Health Secretary, said: “Yet again the Government’s obsession with spin is trying to create a false impression.

  “These are inquiries to a telephone helpline, rather than real recruitment figures.”
  
  New rules for call-outs
  

• Latest figures show that 72 per cent of patients wait longer than two working days to see their GP

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