Out-of-hours GPs 'under pressure'

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A new contract introduced in 2004 meant around nine in 10 doctors opted out of providing the care in return for a drop in salary.

Primary care trusts (PCTs) took on responsibility for weekend and night-time care and employ private firms, groups of doctors and in-house teams to provide cover.

Pulse newspaper said some firms were now introducing performance criteria for GPs, such as measuring the number of home visits, length of telephone conversations and referrals to hospital. It said PCTs were making cuts and out-of-hours providers were having to find savings.

In an email, Dr Mark Reynolds, chief executive and medical director of On Call Care in Kent, said the firm was introducing a 5% reduction in doctors' hours.

"We have had to make this reduction to balance our budget, but also to try to get the most cost effective use of our valuable doctors," the email said.

It said the majority of the firm's doctors "work hard and fairly" but some were outside the average range in terms of work done per hour and the outcomes of conversations with patients.

From now on, outcomes would be measured, including the percentage of calls resolved on the phone, length of calls, and the number of home visits.

The email, seen by Pulse, said that the number of referrals to "ambulance 999 and admissions" would be monitored because "commissioners are beginning to breathe down our necks".

It added: "I hope everyone can understand why we are adopting this approach. "'Dr Anxious' can produce more than twice as much work for the system as 'Dr Perfect', and 'Dr Referalot' can send four times the average to 999 or to hospital."