The current proposals from the Lib Dems are for local GPs to take back their out of hours care, scrapping practice boundaries and to create locally elected health boards.
The practice boundary issue is not really of much concern to us, as geographically our practice area is well defined although we would possibly consider taking on more patients further downstream towards Richmond. The health board shows promise to make sure that health solutions are applicable to the population they serve and any move away from NHS Whitehall and a one-size-fits-all approach is most welcome. Out of hours care is a real concern though. Being responsible for commissioning out of hours cover is one thing, but having to provide 24/7 cover is likely to be unsustainable for a single-GP practice. Not only are there safety issues, but also difficulties finding locum cover for holidays and training days. Such a policy may necessitate a practice merger or at least a change in the way we work.
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The recent survey by the Patients' Association www.patients-association.com/News/356 shows that some out-of-hours services are poor. Surely though the best response is for those who commission these services, the PCTs presumably, to address the issues rather than to opt for a reorganisation of the provision. Making GPs responsible for commissioning out-of-hours services would add an admin burden which I expect you could do without. There are bigger challenges for the NHS than tinkering with this service; improving efficiency and effectiveness in an era of reducing budgets.
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