News

Out-of-hours medical care may be commercialised

The healthier we get, the more medical attention we need. And the easier it is to get pizza, cash or petrol at all hours of the day and night, the more reasonable it is to want a doctor on demand.

The alleged trebling of demand for night visits by general practitioners has generated much emotion amongst family doctors, fuelled by the certainty that the majority of calls are for minor illnesses that need little, if any, medical intervention.

Recent practice has been to contract out night calls to commercial ‘deputising’ doctor services in the cities, or to share the burden through co-operatives in less populous areas.

Half the general practitioners in Britain use some for of deputising service, and this figure rises to 80 per cent in the major cities. The increasing night-time workload is making these options more difficult, as commercial services eat into practice budgets and co-operatives feel the strain of demand.

The medical politicians have put pressure on the government to change the GP contract to allow some withdrawal from out-of-hours responsibilities, but they have hit a stone wall.

The coming conference of the GP political apparatus, the annual gathering of Local Medical Committees, has to consider how to make progress against an intransigent government.

The omens are not good for the doctors, because a consumerist government will only allow GPs to escape from their commitment to night calls if they loose sufficient income to fund a separate night-time service, and in effect lose their monopoly of medical care.

Commercial organisations are ready to act as providers of night calls, serving not the provider GPs (as now) in a subcontractor role, but the purchasers in a direct contractual role. Healthcall Group plc, for example, which already runs deputising services, is re-capitalising through a stock market flotation in ‘order to identify and expand into services..’ including a ‘homecare operation’.

Some general practitioners may enjoy playing the NHS internal market by becoming fundholders — little purchasers — but as a group the profession dislikes competition on a level playing field. If GPs transfer their out-of-hours responsibility to their local administrations, they may find that their local purchasing authority buys services that the family doctors find unsatisfactory, or that their own co-operatives are undercut by rivals, or that gung ho purchasers try to hive off other bits of their jobs.

Small wonder that the medical politicians are pausing for thought and calling for wide discussion. Too much pressure for change may open the door to something akin to deregulation of general practice, and the ability of general practitioners to control their local working environments would be weakened significantly. Too little pressure for change, and the system may not tolerate the strain of rising demand.