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Only local doctors should provide out-of-hours primary care, say experts

30 June 2010

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Only doctors familiar with local health services should provide out-of-hours (OOH) primary care, argue two experts, following the death of a patient given an overdose of diamorphine by an OOH doctor.

This is just one of several wide-ranging changes needed to ensure the quality and safety of OOH care, say Dr Paul Cosford and Dr Justyn Thomas from NHS East of England, in a paper published on

David Gray died after he was wrongly injected with 100 mg diamorphine by Daniel Ubani, a doctor based in Germany and providing OOH primary care in Cambridgeshire.

Dr Ubani made a critical and fatal error, say the authors, but they believe that solely to blame him is to miss several key facts and that a wider examination of the system that allowed him to practise in these circumstances is needed.

They point out that many areas do have high-quality OOH care, but point to other contributing factors in this case and recommend areas for change.

These include a review of laws governing registration of doctors from the European Economic Area. “This is not to prevent the free movement of well qualified doctors,” they explain, “but to recognise that healthcare systems differ across the EU, and that doctors’ competence is at least partly specific to the system in which they work.”

The authors also strongly advocate changes to the PCT performers’ list system. Currently a doctor on one list can practice anywhere in England, but this system should require GPs to be on the list of the PCT where they work, with the extra provision that GPs should be able to enter more than one list if they have good reason.

They also argue that arrangements for OOH primary care should be reviewed locally to ensure that doctors operate within structured teams providing high quality, safe care.

“As a profession, we should not accept a system that allows incidents such as this in any part of the NHS,” they conclude. “Clinical leaders throughout the NHS must advocate and lead the necessary changes.”