Out-of-hours care 'too complex'

The NHS Alliance has said responsibility for out-of-hours care should revert back to GPs in an effort to avoid confusion and fragmented care in the face of a number of different choices.

Services on offer include NHS Direct, walk-in centres, minor injury units, urgent care and out-of-hours centres, all trying to fill the gap between the GP surgery and the hospital A&E, a report by the Alliance said.

The study, In Sickness and In Health, said that under the current system, there was a risk that some would not get the timely care they needed - and that more patients would default to &E, putting more pressure on hospitals.

Reclaiming responsibility for out-of-hours services would not necessarily mean that GPs provided all the care themselves, the study said - and such a move would be "impossible and unsafe". But it would mean the GP practice would be responsible for services - to "join up" care and make sure patients did not fall into any gaps, it said.

The report, aimed at informing the review of the NHS currently under way by Lord Darzi, said the majority of patients suffered from long-term conditions and could not be treated as a one-off episode of hospital care.

A system of integrated health services designed around the patient, instead of expecting the patient to fit the system, was necessary, the report said, offering access "when and where" patients needed it, round the clock.

The report called for a number of measures including the creation of a new breed of doctor, a community specialist consultant, a post equivalent to a hospital consultant but with special training in the skills needed to work across the boundaries between hospitals and primary care.

Expensive new super clinics might not work where they were a long way from patients and there was no transport, it warned.

Collaboration between GP practices, specialist doctors and other services might be more cost effective and give the same quality of care as new build polyclinics, it said.