The Conservatives have renewed their pledge to challenge GPs' controversial contracts after an inquest into the death of a Cambridgeshire pensioner given an overdose.
David Gray, 70, from Manea, died in February 2008 after receiving too much diamorphine from German locum Dr Daniel Ubani, who flew from Germany the day before to be on call out-of-hours.
Dr Ubani claimed his own tiredness led to the death. He was working for private company Take Care Now, subcontracted by the Cambridgeshire PCT to provide out-of-hours care.
Shadow Health Secretary Andrew Lansley said the case proved it had been a mistake to let GPs give up after-hours care. He renewed his party's promise to challenge the contracts.
A Conservative government would make GPs "collectively responsible" for commissioning out-of-hours services, he said. "They are best placed to ensure patients are treated properly and that these awful events are never repeated."
However, the British Medical Association is likely to resist any change in the GP contract, which was introduced after doctors persuaded ministers that they were overworked and underpaid compared to other medics.
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"I am with Mike Robinson [comment below] – by the end of a full day in work (perhaps something that MPs are not familiar with?), anybody is too tired to properly and safely treat patients. In general what is needed is education and adequate management of patient expectation and demamd to reduce demands on GPs overall, including out-of-hours. Time spent dealing with minor self-limiting conditions would be better spent dealing with those who really need it and would reduce stress, improve access for the genuinely needy and feed through to hopefully reduce the likely repeat of this sort of situation" – Name and address withheld
"Jim Bond [comment below] said 'the fault does not lay with general practice, the contract or even with doctor concerned in the case, but with the PCT-commissioned out-of-hours provider.' I do not agree. How the fault does NOT rest with the doctor concerned is beyond me. The doctor administered this fatal dose, no one else.To claim he was too tired is unacceptable. If he was too tired he should have refused to work. If a truck driver exceeded his working hours and was too tired and killed someone it would be his fault and his haulage company for failing to police/control the situation. This German GP was negligent – full stop. The OOH contractor must also be culpable insofar that they have failed in their duty to ensure that their clinician was 'fit to practice'. How it can be 'cost effective' or 'clinically sound' to fly in GPs from overseas to cover temporary work rotas is very disturbing too. The GP contract has nothing to do with it, nor in my opinion does the PCT. This is a cheap backdoor trick to revisit GP contracts. Shame on YOU Andrew Lansley" – Steve Cribb, Hove
"Again we have a MP (of whatever shade, they are all the same) challenging the wrong organisation. The fault does not lay with general practice, the contract or even with doctor concerned in the case, but with the PCT-commissioned out-of-hours provider. It would appear to me that PCTs commission services based on cost alone with out the quality element being monitored. I agree with Mike to have GPs cover OOH after a full day is as dangerous as what happened in this case. If there is a wish for GPs to be involved maybe a realistic OOH commisioning budget should be devolved to PBC or PCTs should ensure that PBC are fully happy with OOH commissioned by them intead of often just presenting a fait accomplie. I should point out that OOH in our area seems pretty solid, could that be because GPs were involved in the commissoning process?" – Jim Bond, Manchester
"I do not think GPs should take back out of hours but feel that they should be consulted regarding out-of-hours care, quite often the decision for the out-of-hours provider is taken by the PCT and often it is the lowest tender" – Lesley Beale, Essex
"I am now more than ever convinced that the Conservatives do not understand the fundamentals of general practice or understand that often the people doing the out-of-hours are one and the same. It is wrong to put the emphasis back onto GPs. They have already done a full day and then to do an evening as well is not a safe idea. At least at the moment it is a choice if they wish to do extra and can be arranged around the day job. I wonder if the Conservatives have ever discussed with a practice manager what they are proposing. I think not. The workhorses of the NHS are rarely asked for an opinion" – Mike Robinson, Yorkshire