Clause 21 - out of hours medical services
Health and Social Care Bill
11:00 am
Dr Peter Brand (Isle of Wight, Liberal Democrat)
I do not want discussion on the clause to focus solely on NHS Direct. However, it is clearly an evolving service that is having problems during its evolution. Not only has it found it difficult to cope with capacity, but there have also been significant problems with the computer programmes on which the advice is based. It can take a long time to get hold of someone, and the assessment process by an NHS Direct assessor is very time consuming. Sometimes advice is also a little too direct. One of my wife's patients told her that NHS Direct had told the mother that the child had to be seen by a doctor within an hour. It is not the role of NHS Direct to dictate how a patient should be seen, or at least I do not believe that it should be. Those issues must be resolved in time.
I worry that NHS Direct is a free service to GPs. In effect, GPs are being bribed into using NHS Direct because they are pragmatic people who will use a free service. However, it is not a free good and we must recognise that public money is spent on that service. Let us hope that it works out well.
My concern about the clause is that a health authority may be reluctant to sanction any other other-of-hours services as out-of-hours first-line-of-call access is free through NHS Direct. Would arrangements made by individual contractors—to have internal rotas, for example—also have to be approved by the health authority, or could those contractors retain their individual 24-hours-a-day responsibility? I was in a single-handed practice for about 15 years, and I was on call every night apart from Thursday, through a rota with colleagues. That worked well, except that one of my colleagues, who was not terribly reliable, put a message on the answer phone saying, ``If there are any problems, ring me at home''.
Such methods are no longer acceptable to most practitioners, and would not be to me now, because patients' attitudes have changed. That is perhaps part of increasing consumerism, which the Government have fuelled by raising patients' expectations that there should be access to just about anything, 24 hours a day. That issue needs to be addressed, but not in this debate.