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Letters Locum issues

The elephant in out of hours primary care

BMJ 2010; 341 doi: (Published 21 July 2010) Cite this as: BMJ 2010;341:c3881
  1. Timothy Jefferson Cantor, freelance locum general practitioner1
  1. 1Charlton House, Ryarsh, West Malling, Kent ME19 5JS
  1. tim.cantor{at}

    Cosford and Thomas identify factors possibly contributing to the death of David Gray at the hands of Daniel Ubani,1 but they ignore the elephant in the living room—namely, payment rates for general practitioners (GPs) who volunteer to work for out of hours providers.

    Since primary care trusts took over responsibility for commissioning out of hours care, out of hours providers have come under increasing pressure to cut costs. This has resulted in pay rates being cut, or at least not increased in line with inflation. Staffing levels on some shifts have been cut too. In short, GPs who volunteer to work for out of hours providers are, on the whole, doing more work for less pay. This has led many GPs to cease working for their local out of hours providers. Others, myself included, are hanging on in there, but volunteering for fewer shifts than previously. This has forced out of hours providers to depend more heavily on agency doctors to fill unstaffed shifts. Some of these doctors are unfamiliar with local healthcare arrangements and, I suspect, the computer systems that they are required to use.

    Politicians and NHS administrators talk sanctimoniously about delivering value for money to the taxpayer. They need to be reminded that sometimes value for money comes at a price that can be measured in human life.


    Cite this as: BMJ 2010;341:c3881


    • Competing interests: TJC works on an ad hoc basis for South East Health, an out of hours provider.


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