The tragic death of a 70-year old man, caused by a 100mg diamorphine overdose administered by an out-of-hours European GP, calls for a careful review of the delivery of out-of-hours services and the employment of temporary and foreign GPs, says the NHS Alliance.
Dr Daniel Ubani, a doctor from Germany, injected patient David Gray with 10 times the usual dose of diamorphine. Dr Ubani was given a nine-month suspended sentence in Germany for negligence in 2008, and a fine of 5,000 Euros.
The case has led to calls for an urgent review of out-of-hours provision. Among those calling for changes is David Gray's son Stuart, who is himself a GP.
An investigation by BBC's Newsnight established that best policy guidelines were not followed by the company that employed Dr Ubani. The Care Quality Commission is investigating the case.
In a letter of apology to David Gray's family, Dr Ubani wrote: "My nerves were overstretched, I was too tired and lacked concentration and these factors played a major role in the mistake that occurred."
The NHS Alliance says the case requires "the right lessons" to be learnt over the tragic error. It says the case highlights issues around the knowledge and expertise of some European doctors who, under EU rules, are entitled to practise in the UK without further assessment or training here.
EU rules to support the free movement of labour across national boundaries require "equivalence" to be given to EU-qualified doctors, so that they can join the UK General Medical Council and PCT Performers' lists.
However some EU-qualified doctors acquired their rights to practise without any specific training in general practice. This is because they had already begun their professional practice in their country of professional origin before that country introduced general practice training regulations.
By contrast, doctors of non-EU origin are required to undertake thorough clinical and English language assessment and training – a process that takes several months.
The NHS Alliance Urgent Primary Care Network believes this case raises key issues about the potential impact on patient safety of these rules. It says that the Care Quality Commission review following this case needs to look closely at the implications of these issues.
According to the Alliance, unless out-of-hours providers feel they can be reliably assured over issues of training, language and hours worked, they should perhaps err on the side of patient safety and not use any temporary GPs – "from the EU or anywhere else."
Edmund Jahn, managing director of out-of-hours provider Harmoni and the NHS Alliance Urgent Primary Care Network, said: "This tragic case should, and no doubt will, make out-of-hours providers review carefully the use of doctors whose experience is in a foreign health system, working for an out-of-hours service at short notice and with minimal checks.
"EU-qualified doctors can be a useful element in the mix, but only if out-of-hours providers can assure themselves over their employees' fitness to practice out-of-hours as they would do for any local GP doing the same job".
Dr Ray Montague, of out-of-hours providers BrisDoc and member of the NHS Alliance Urgent Primary Care Network, said: "This shocking and tragic case should sharpen all our thinking about the delivery of out-of-hours care. We cannot risk another case like this.
"The government and professional bodies must help providers to put in place necessary measures to ensure that all doctors who practise in Britain are trained to British standards, and that all patients are protected."
Your comments (terms and conditions apply):
"It says something for privatising the delivery of services in the name of progress and evolution. So really, it is the government which is responsible for creating an environment fit for such tragedies to take place – not so much the genuine OOH services" – Name and address withheld