Most GPs are expected to opt-out of 24-hour care

The Commons Health Committee issued its warning in a report into out-of-hours care in England.

Under changes being introduced over the next few months, GPs can opt-out of seeing patients outside surgery hours.

The responsibility moves to local health bodies, but the MPs warn many are not ready for the change, and there could be significant funding gaps.

The British Medical Association estimates around 90% of GPs will choose to opt out.

Market rates

GPs currently receive �6,000 a year for providing out-of-hours cover.

One witness argued that it could seem at times as if PCTs were operating in a different 'universe', assuming everything was fine. David Hinchliffe, Health Select Committee chairman

Where they opt out of 24-hour cover the cash will go to the local Primary Care Trust (PCT), as well as a top-up fee of around per GP.

The committee says that even if PCTs use other healthcare staff such as nurses to provide some care, GPs are still likely to make up a significant proportion of the out-of-hours workforce.

And the committee warned the funding will not cover the full cost of replacing the existing service.

The report said this was mainly because the traditional obligation GPs felt to provide evening and weekend care had "largely disguised" the true cost of the service.

David Hinchliffe, chairman of the committee, said that would become apparent "once GPs are paid at a market rate for their time".

In its report, the committee added: "It is clear from our evidence that there is anxiety in many quarters about securing adequate funding for GP out-of-hours services."

MPs heard evidence that paying "acceptable" hourly rates for GPs suggested there could be a funding shortfall of around �300,000 per PCT - and in some cases, much more.

'Fair reward'

Mr Hinchliffe also said that there were "varying states of readiness across the country" for the new system.

He added: "Some witnesses argued that this important issue was being managed at too junior a level.

HAVE YOUR SAY If it's not serious enough to take time out of work then it isn't serious enough to waste the GP's time John B, UK Send us your comments

"One witness argued that it could seem at times as if PCTs were operating in a different 'universe', assuming everything was fine."

He said health chiefs had to keep a close eye on the situation when the new system fully comes into force on December 31.

Committee member Dr Doug Naysmith said: "Some PCTs are ready and some are not. It's a kind of patchy provision over the country.

"Some have not identified the finances they are going to need to take over the service and that's possibly one of the most important problems that we anticipated.

"The other thing is we are not sure in many places who is going to provide the out-of-hours service and how it's going to be provided.

"There's a good indication that the number of doctors who are doing it now will not be the same ones and in the same numbers in the future," he said.

Dr Hamish Meldrum, chairman of the BMA's GPs' committee, said: "We told the Health Committee that more than 90% of practices are likely to hand over responsibility for out-of-hours cover to their local primary care organisation by the end of the year.

"But on an individual basis, many doctors are willing to work outside normal hours for a fair reward."

Dr Gill Morgan, chief executive of the NHS Confederation, which represents PCTs, said the changes would be a "real challenge" to implement.

She added: "Although a minority of PCTs may experience significant pressure in the run-up to the January 2005 deadline, we are confident that all PCTs will secure a safe and effective service for patients."

Health Minister John Hutton said the government was fully committed to providing high quality out-of-hours services .

But Liberal Democrat health spokesman Paul Burstow, who is on the Health Select Committee, said: "This report demonstrates that when it comes to out-of-hours care, the government is forcing the local NHS to tread a tightrope."