New figures released show that the current cutbacks will affect services and put patients at risk as one in four NHS Trusts cut spending on out-of-hours care.
To date, at least 20 trusts have reduced their budgets for doctors visiting patients in out-of-surgery hours by a total of £4 million.
As NHS Trusts cut after-hours budgets – concerns are being voiced to ensure a repeat of the incompetent German locum Daniel Ubani who killed a Cambridgeshire man with a morphine overdose in 2008 doesn’t happen again.
Obtained under the Freedom of Information Act, around 78 of England’s 152 primary care trusts released information on their out-of-hours spending. Out of the trusts that supplied information, twenty said they had cut their budgets.
Furthermore, the cuts made to out-of-hours care were made in the trusts’ 2010-11 budgets, before the government’s NHS spending review, which will see the NHS making efficiency savings of £20 billion over the next four years.
Across the remaining trusts that released information, total spending on out-of-hours care rose by £3.6 million.
Health experts, said, “some trusts might have been able to make savings without affecting services, by renegotiating inflated contracts.”
However, doctors and patients’ groups, said, “That in many cased lower spending would add to concern about the quality of care.”
Last year the Department of Health commissioned a study into the quality of care provided by out-of-hours contractors, including GP groups and private health care firms and the findings highlight a wide variation in the services provided to patients.
Katherine Murphy, the chief executive of Patients’ Association, said, “The latest cuts would reduce the quality of care, risking a repeat of the case of Dr Ubani.”
“By pressuring providers to look for ever cheaper options, the government is forcing them to enter a race to the bottom.”
“Out-of-hours services need to be staffed by doctors who are trained and experienced as their colleagues who work during the day. Cutting funds to pay for them will mean fewer and possible less able doctors.”
Dr Fay Wilson, who chairs an out-of-hours group in Birmingham, said, “Cutting out-of-hours care was a ‘false economy’ for trusts because more patients would be forced to seek care from accident and emergency wards.”
“If you are going to reduce the cost, then you will be reducing the number of clinicians you have on. That leaves gaps. You also don’t get the same level of supervision and support.”
Richard Vautrey, of the British Medical Association, said, “Cutting costs could harm services. There is a concern that you can pare a service down to such a level and reduce funding to such a level that you put patient safety issues at a higher risk.”
A Department of Health spokesman, said, “The Coalition was improving out-of-hours care. This is not about cutting costs – we are investing an extra £10.7billion in the NHS – it’s about ensuring GPs, not bureaucrats, are responsible for securing safe and appropriate out-of-hours care.”
The BMA also published a poll, which it said showed that most GPs opposed the Government’s plans to give them control over £80 billion of NHS budgets.
The BMA poll highlighted that about 65% of family doctors believe competition between providers, including NHS and private companies, will reduce the quality of patient care, while 61% said, “the Government’s reforms mean they will spend less time with patients.”
The Department of Health, said, “The survey showed some doctors had ‘misconceptions’ of the planned reforms.”
Health Secretary, Andrew Lansley, said, “There was no alternative to his reforms to make the health service more efficient.”
“Unless we modernise, every year the relative costs of running the NHS will go up. Demand will grow, the bureaucracy will expand and inefficiencies will become entrenched.”
“There is no easy option. Sticking with the status quo and hoping that a bit more money will be enough to meet the challenges ahead is complete fiction.”
John Healey, Labours health spokesman, said, “The Government’s wasteful and reckless reorganisation of the NHS is piling pressure and uncertainty on health managers.”
“With many seeking short-term savings rather than making long term improvements, this will damage patient care.”
“So much for David Cameron’s pledge to protect the NHS – the reality is that it’s his biggest broken promise to date.”
With NHS Trusts looking to reduce spending, as well as the NHS reform bill being pushed through, the main concern from clinicians is patient care will suffer, particularly out-of-hours care. As the demand for GPs and GP Locums is unlikely to decrease, the need to allocate resources efficiently will rise.
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