Night care centres to help cut GP home visits: Change follows 'explosion' in out-of-hours calls

THE GOVERNMENT has agreed in principle to a sharp cut in night visits by family doctors. Patients will be invited to travel to primary care emergency centres - usually a doctors' surgery - if they want to see a GP out-of-hours.

The change - the biggest in patient night cover since the NHS was founded - is to be negotiated between the British Medial Association and ministers.

Under the new system, patients will be invited to attend a centre which may involve them travelling appreciably further than to their local surgery.

The move follows a dramatic explosion in demand for out-of-hours visits, with visits doubling in the past three years to 1.64 million in England, Dr John Chisholm, deputy chairman of the BMA's family doctors' committee, said yesterday. There was no underlying clinical explanation for the increase, he said. It simply appeared that more patients wanted a GP service available 24 hours a day, with patients seeking care out of hours for conditions that were not emergencies.

The rise in demand, however, meant 'the system is approaching the point of collapse,' he said. The Government, which has to pay the expenses of more night visits, 'cannot afford to continue the service if demand continues to rise' and action was needed 'before disillusioned and exhausted GPs start making mistakes'.

Family doctors were looking for a system where 'instead of having thousands of GPs and their deputies on call every night, we are talking of hundreds, by organising the care better and ensuring we do not have this nonsense of having GPs up on call and stressed at night and then having to work the following day'. The centres would often be adapted GPs' surgeries, but a few specialist centres might be built. The move would mean more patients would be seen in properly equipped surgeries, he argued, rather than at home.

Home visits will remain available, and GPs will not have to switch to the new system, but the doctor will be able to invite patients to the centres or offer telephone advice, Dr Chisholm said. In Medway, where a pilot scheme has been run, half the patients who called had agreed to visit the centre, he said.

Brian Mawhinney, the Minister for Health, in a letter to GPs' leaders, says that he agrees 'in principle' to the idea. 'I envisage that these centres could . . . become the principal location from which emergency primary care is provided out of hours.'

As part of the change he has also in principle agreed to doctors losing their nominal 24-hour responsibility for patients, which they will be able to transfer out of hours to 'properly registered deputies'. These will be clinically responsible for their own actions - at present a GP who allows another to deputise remains responsible for the replacement doctor's actions.

Dr Chisholm said the centres might see one doctor on duty per 100,000 population when a typical five-doctor practice might have just over 10,000 patients.

Dr Mawhinney's letter says that while the Government will need to make provision for 'appropriate growth in demand for emergency care', it also needs to 'inhibit inappropriate demands', and a campaign urging the public to use GP services properly is being prepared.