Quality | 2010.02.02
NHS trusts 'breaking law' on out-of-hours GP services
Some trusts not checking English skills, according to review set up after man was killed by German locum\'s painkiller overdose
There is an "unacceptable" variation in the quality of out-of-hours GP services in England, a government report will say this week.
Some NHS trusts are breaking the law by failing to check whether foreign GPs can speak English well, according to the review which was set up after a patient was killed by a German locum on his first UK job.
The report will call for improved induction and training, and a national database of doctors covering out-of-hours services.
The stark findings are likely to further increase unease about the quality of out-of-hours services after the Guardian revealed details of the case of 70-year-old David Gray , who was given 10 times the normal maximum of painkiller by Dr Daniel Ubani.
However the report will also say that, overall, standards have improved since services were reorganised in 2004. It will be published after the inquest into the deaths of Gray and another patient in Wisbech, Cambridgeshire, ends on Thursday.
A new GP contract introduced more than five years ago shifted responsibility for out-of-hours services from local doctors and put it in the hands of NHS bodies and private companies employing a mix of local GPs, locums from agencies and sometimes doctors from abroad. Regulations introduced at the same time were meant to ensure sufficient checks were made on doctors\' competence and knowledge of English.
The report, by David Colin-Thomé, clinical director for primary care at the Department of Health, and Steve Field, chairman of the Royal College of General Practioners , is also expected to say that measures such as induction and training of GPs who have never worked in an area before must be improved. There should be a national database that would allow trusts and private companies to check whether doctors had previously failed to get on to performers\' lists, the ticket to work in the UK providing their medical qualifications are satisfactory, and they had proved their competence in English. These moves were recommended in a previous report unrelated to the Ubani case nearly a year ago but have so far not been implemented.
The furore over Gray\'s death – compounded by a row between UK and German prosecution authorities over where Ubani should face criminal proceedings, and continuing safety concerns over potent painkillers in the NHS – followed an outcry over the death of Penny Campbell in 2005. The 41-year-old journalist died from septicaemia, which was not diagnosed by eight different practitioners working for a doctors\' co-operative in north London. It has emerged recently that 600,000 patients in Suffolk are covered by only two GPs after midnight, while Alan Beith, Liberal Democrat MP for Berwick-on-Tweed, last week told a House of Commons debate that some patients in north Northumberland had to contact doctors at a base 60 miles away.
Ubani failed in his first attempt to work in Britain because he did not reach the required standard in English, the Guardian revealed last year . He was later admitted to the performers\' list by Cornwall and Isles of Scilly NHS, which had less rigorous checks. He never actually worked there and killed Gray at his home in Manea, Cambridgeshire, on his first UK job months later.
Remarks made by the health minister Mike O\'Brien in the Commons debate last week indicate other trusts are similarly lax and are breaking the law, although he is resisting Liberal Democrat calls for criminal rather than civil offences. He says money to pay fines would have to come out of NHS budgets meaning patients would suffer further.
His department was unable last week to explain what penalties or consequences local NHS managers or private companies could face if they failed to meet their legal obligations. However it is strongly encouraging all 152 trusts commissioning out-of-hours services to join a benchmarking exercise run by the Primary Care Foundation and funded by the department and trusts. So far 86 trusts have signed up to the anonymised system of performance checks, including assessment of urgent cases, filling of shifts, use of doctors not local to an area, and costs per head of population.
O\'Brien told BBC\'s Newsnight last month: "If I call a doctor out in the middle of the night to my kids, I don\'t want them flying off a plane from somewhere in Europe who can\'t speak English looking after my kids. Nobody does."
Of 34,000 GPs working in England, about 7,400 qualified abroad. Inquiries by the Guardian and witnesses at the inquest have revealed conflicting views on Ubani\'s English and general communication skills, although a letter he wrote to the Gray family in 2008 apologising for his mistake contained several spelling mistakes and poor punctuation. He admitted being tired and unfamiliar with the drug he used.
A separate investigation into the lessons to be learned from the case will be published by the NHS watchdog, the Care Quality Commission, later this year. Its interim findings published last October identified a number of concerns, including unfilled shifts and insufficient monitoring of standards by NHS managers. Ubani was convicted of causing Gray\'s death by negligence by German authorities, given a nine-month suspended prison sentence and order to pay €5000 costs. He is still working as a doctor in Germany but is suspended from practice in the UK.
For more information, please visit
http://www.guardian.co.uk/society/2010/feb/02/nhs-trusts-out-hours-gp
