Government preparations for a new out-of-hours GP service were “shambolic”, a report from the Public Accounts Committee has found.

Doctors were allowed to opt out of providing a 24-hour service in return for a salary sacrifice of only £6,000 each — half what the service costs to provide. The Department of Health was not directly involved in the negotiations and never clearly defined what it wanted.

Poor monitoring means that some primary care trusts do not know whether the services they provide are any good. In cases where quality has been measured, performance is poor.

The department overlooked the fact that ending Saturday surgeries would be inconvenient for many patients, the committee said.

It also allocated £70 million less to trusts than the new service cost to provide, forcing them to incur deficits or to cut budgets for other services.

Edward Leigh, Conservative MP for Gainsborough and chairman of the committee, said: “The Department of Health thoroughly mishandled the introduction of the new system of out-of-hours care. The department chose to act as an observer, and no more, in the negotiations with GPs’ representatives. This hands-off approach was good news for the doctors but no one else. They were given a strong incentive to opt out — a lot less work for a small loss of income — and a disproportionate amount of taxpayers’ money is now having to be spent to provide the replacement service.”

About nine million patients require out-of-hours care in England each year. This is provided by in-house primary care trust teams, GP cooperatives and private companies.

Mr Leigh added: “The new service is getting better, but the needs of patients are not best served by the ending of Saturday morning surgeries. They are not best served where access to advice and treatment is often extremely difficult and slow; and they are not best served where no one knows whether the service is meant for urgent cases only or for any requests for help at all.

“To cap it all, the cost of the new service is around £70 million a year more than was expected. That’s the last thing the primary care trusts need at this time of increasing financial pressure.”

The total allocated by the Department of Health to trusts for out-of-hours services in 2005-06 was £322 million, according to the report from the Public Accounts Committee. However, figures from the National Audit Office showed that actual spending in 2005-06 was likely to be £392 million.

Those who provide out-of-hours care have been set targets relating to how long it takes to answer a call and to assess whether a patient is an emergency case. But the percentage of trusts meeting the targets was extremely low, the report said.

Stephen O’Brien, the Conservative health spokesman, said: “The Government has failed on out-of-hours provision. Everyone up and down the country is suffering because of it. Patricia Hewitt’s pitiful attempt to claw back money from GPs is to try and shut the gate after the horse has bolted.

“Not only has the extra cost added to the billion-pound cash crisis in our NHS, but it has pushed more people into busy A&E units, putting greater pressure on our hospitals.”

Norman Lamb, of the Liberal Democrats, said: “Yet again, the Government has grossly mishandled an NHS contract, putting further pressure on cash-strapped trusts and leaving patients confused about where care is being provided. The effect of this mess is that A&E services will be swamped by patients who don’t know where else to turn.”

The Department of Health claimed that “most patients” were benefiting from improvements in out-of-hours services thanks to the new arrangements, and denied that the ending of Saturday surgeries had anything to do with the new contract.

A spokesman said: “Patients right across the country should now be assured timely and responsive care, including the guarantee of a face-to-face consultation with a GP if needed.

“It was clear from the rising number of complaints that the previous system was not meeting patients’ needs and was affecting the ability to recruit and retain GPs.”

Hamish Meldrum, chairman of the British Medical Assoca-tion’s GPs Committee, said: “We would confirm the committee’s findings that the quality of many out-of-hours services leaves a lot to be desired. We have commented about this both nationally and locally.

“However, we would reject the implication that GPs were the only ones to do well out of this deal and that the Government was not really involved. The Department of Health was fully aware at all stages of the negotiations about the opt-out price.”

Sugared pill

-Before 2004 GPs were responsible for their patients 24 hours a day. For out-of-hours care (6.30pm to 8am weekdays and all weekend) they either did it themselves, shared the load with other doctors or employed locums

-The new contract allowed them to opt out of 24-hour care by sacrificing £6,000 a year. Ninety per cent of GPs accepted

-Primary care trusts had to organise out-of-hours care by employing GPs, private companies or even GPs who had opted out of providing it themselves

-As a whole, the new contract gave GPs a big rise in pay, raising the average to nearly £100,000. A points system that rewards GPs for a quality service easily exceeds what they lost in giving up out-of-hours care

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