Concern over out-of-hours care

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Dr Anthony Harnden, a lecturer in general practice at Oxford University, expressed concern over the different skills and experience of staff managing care after GP surgeries close.

He said there should be less telephone advice and more face-to-face assessments.

Controversy has raged over the changes to out-of-hours care in England, which were introduced in 2004. The Government negotiated a contract with GPs which led to more than 90% of them opting out of providing out-of-hours care.

The cover became the responsibility of primary care trusts, which use a mixture of providers, including in-house agencies and private firms.

Writing in the British Medical Journal (BMJ), Dr Harnden said: "Doctors, nurses, staff working for the telephone helpline NHS Direct, out-of-hours centres and accident and emergency departments may all have different levels of skill and experience.

"This is a major concern because the most solid evidence for recognising clinical severity in febrile (feverish) children in primary care is a global assessment by an experienced clinician.

"The global assessment involves eliciting a clear history and careful observation of signs, including alertness, activity, colour and respiratory effort."