Patients lose access to GPs at night

Patients will lose instant access to their family doctor at night and at weekends under plans by the Government to make NHS Direct - the health telephone helpline service - handle all out-of-hours calls for GPs.

Patients will lose instant access to their family doctor at night and at weekends under plans by the Government to make NHS Direct - the health telephone helpline service - handle all out-of-hours calls for GPs.

In future, patients who ring their GP at night or at weekends will be answered by qualified nurses manning the NHS Direct switchboards.

Previously they would have been passed on to another GP or a commercial deputising service.

Non-urgent cases will be offered advice and told to seek an appointment with their doctor in the morning, while walking wounded could be asked to seek treatment at local accident and emergency units.

For urgent cases, NHS Direct operators will ask doctors to make home visits, but they may call out commercial deputising services rather than patient's own GPs to respond to requests for treatment.

The decision to use NHS Direct to handle out-of-hours calls for GPs alarmed doctors' leaders, and it is understood that Downing Street delayed the announcement by Alan Milburn, the Secretary of State for Health, in order to seek assurances that the telephone service will be able to cope with the extra demand.

Mr Milburn will couple his announcement in a fortnight's time with extra resources to guarantee that NHS Direct will be able to meet the extra demands being placed upon it. "We are not about to implement a system that cannot cope," said a ministerial source.

The helpline will do away with the traditional image of GPs as "Doctor Finlay" figures, ready to turn out at all times of the night for their patients. However, the Government is concerned that this image was largely a myth in many towns and cities.

Ministers are adamant that the changes will improve the service to patients by reducing the reliance on commercial deputising services, which have increasingly taken over the handling of night calls.

GPs will remain responsible for the patients on their lists, in spite of the new role taken by NHS Direct, following a review of out-of-hours services by medical leaders.

The review was ordered by the Secretary of State after a series of highly critical reports by the Health Service Ombudsman, Michael Buckley, on cases where GPs or deputising services had failed to respond to calls properly.

In June the Ombudsman condemned a deputising service in Lancashire for a case in which there was a delay of nearly three hours before the doctor was told about an emergency call.

He said it was "totally unacceptable" that the prioritisation of calls was being done by staff who were not clinically qualified. The operator had failed to note that the patient - who died in hospital - was unresponsive, which would have prompted more urgent action.

"There is concern that the NHS will not be able to cope with the volume of calls that it has to deal with," said one member of the review team.

"Last Christmas and New Year we heard stories about clerks pretending to be recorded answering messages because the lines were overloaded. It was alleged that some calls were taking 25 minutes to get through to NHS Direct. You are talking about a very great increase in NHS Direct."

A government source said: "A lot of the provision of out-of-hours cover is widely differing. It is not just a question of the types of provision - it is the difference in access standards that we want to tackle.

"If you go to some parts of the country, you get a whole nest of different answering systems. That is potentially quite confusing for patients. In other parts of the country, the response is much swifter. It is the access that we are concerned about and how long people have to wait for different sorts of triage systems."

The source added: "If we are going to expect NHS Direct to expand what they do, they will be backed with more money. It is not just about increasing the number of people they employ; it is about getting the right sorts of computer systems, and the right kinds of information."