The disclosure that just two GPs are available for out-of-hours duty in the county of Suffolk is the inevitable consequence of the contract with family doctors negotiated by the Health Department in 2004. Such sparse coverage is now commonplace throughout rural England, to the detriment of patient care. GP services have come under renewed scrutiny after the death of a 70-year-old man in Cambridgeshire who was given an overdose of diamorphine by a German doctor working for a group that arranges evening and weekend cover. In Suffolk, a baby died while its parents waited four hours for an over-stretched duty doctor to call back. A report by the Primary Care Foundation found that only 16 of the 80 primary care trusts it examined met the target of clinically assessing 90 per cent of urgent calls within 20 minutes.
A dangerous spiral of decline has taken place since the new contract was agreed. Some GPs have opted out altogether from out-of-hours services while others continue to offer them at higher rates. However, funding has been reduced, forcing trusts to look at cheaper contracts, which results in a cut in the number of doctors employed and their replacement by nurses, paramedics, help lines and walk-in centres. In many parts of the country, out-of-hours services are now disconnected from mainstream general practice and provided by doctors untrained in British primary care. Many people faced with uncertainty about GP cover are tempted to use hospital A&E services. However, these are overstretched as well. The European working time directive has forced Britain to cut the hours of junior hospital doctors to a maximum of 48 a week just as their workload is growing. As if this was not bad enough, we report today that the European Commission is stepping up the pressure for other British exemptions to the directive to be removed, despite the damage it has already caused to business and our public services.