The few defiant GPs who still put patients' needs first by refusing to stop their out-of-hours service By Thea Jourdan For most of us, house calls from a local doctor at evenings and weekends seem a quaint remnant of the past - more fitting in Dr Finlay's Casebook than our modern health service. This is because since changes in their contract in 2004, the vast majority of GPs no longer take responsibility for their own out-of-hours care. Instead, it's up to the local health authority to provide it - these authorities, in turn, often use contractors to provide the service. However, a small band of doctors refused to relinquish this responsibility. Around one in ten continue to treat their patients out-of-hours, many via GP co-operatives. These not-for-profit organisations are run by GPs, explains Dr Riaz Jetha, a director of SELDOC, a GP co-operative that caters for one million patients in South-East London. (File picture) Since 2004 it's up to the local health authority to provide out-of-hours in most areas - these authorities, in turn, often use contractors to provide the service 'Our motto is "you are caring for your colleagues' patients." It feels good to be working for a local organisation that puts patients first,' he says. I like to think that local doctors have a unique understanding of what local patients need and what local services there are. For example, an elderly patient may be assisted by a district nurse or a community team that could prevent an admission to hospital. The service was established in 1994, ten years before the GP contract that would enable doctors to opt out of out-of-hours care. Doctors were happy and did not want to change the service. There was pride that we already had a good co-operative that patients trusted,' says Dr Jetha. GPs who are members of the co-op pay a subscription and elect a board. Dr Jetha himself works one out-of-hours shift each week alongside his regular surgeries. When patients call the out-of-hours service, they first speak to trained call handlers employed by the co-operative, who assesses the seriousness of the condition. They pass on the details to a local GP, who calls the patient within 20 minutes for an urgent call and within an hour for a routine call. (File picture) For many co-operatives like SELDOC, the future looks uncertain - if they go under, patients will be the losers Last year, the first ever Primary Care Foundation report compared patient satisfaction with out-of-hours services provided by private contractors to those provided by not-for-profit organisations and NHS providers. The analysis found that private providers were paid an average of £8.11 per head compared with £7.39 for not-for-profit organisations (such as SELDOC) and £9.10 for NHS providers (such as those working in walk-in clinics). But just 59.5 per cent of private services were rated good or very good by patients, compared with 65 per cent of not-for-profit services and 64.7 per cent of NHS services. Yet even though patients rate GP co-operatives highly, and they offer better value for money, many are being forced to disband. After 2004, Primary Care Trusts could commission out-of-hours services according to tenders. Some successful co-operatives have been unable to match the tenders of larger private companies, and so went out of business. This happened in Buckinghamshire when the GP co-operative was forced to close overnight when the Primary Care Trust awarded the contract to a large company called Harmoni. In Cornwall, Kernowdoc - a co-operative with an exemplary record - was passed over in favour of Serco, an international company that carries out school inspections and operates prisons and whose record is hardly glowing. And in 2012 a group of GPs in East London were told they couldn't submit a bid to takeover out-of-hours care from Harmoni - for administrative reasons. Instead, Harmoni's contract was extended without any tender process. SELDOC has survived because it has huge support from doctors and patients, says Dr Jetha. The Primary Care Trust has no option but to keep it because the GPs did not sign their responsibilities away. He thinks co-ops should win tenders on the basis of performance, but agrees they often lack the expertise of a company like Harmoni in putting together tenders. For many co-operatives, the future looks uncertain - if they go under, patients will be the losers.