Chancellor and future prime minister Gordon Brown’s reported intention to take reshuffle GP out-of-hours services seems timely in light of the results of an inquiry into the death of a patient who had sought help from eight doctors over a bank holiday weekend.

Forty-one year old Penny Campbell’s death followed complications from a routine surgical procedure carried out six days earlier at a London hospital. Over the 2005 Easter bank holiday weekend, Penny contacted the consultant surgeon and subsequently eight doctors working with the local out-of-hours service, Camidoc, when she started to feel increasingly unwell.

But none of the doctors diagnosed septicaemia, and Penny died in hospital after attending an Accident and Emergency department. A coroner’s inquest last year concluded that she “died as the result of an accidental adverse healthcare event to which the non-recognition of the seriousness of her condition contributed,” according to the report commissioned by Camidoc.

Ill prepared

The investigation found that part of the problem in failing to recognise Penny’s condition was the difficulty in accessing her notes from earlier consultations, and that Camidoc’s “failure to address these risks, together with its failure to undertake an immediate formal review following Penny Campbell’s death, is indicative of weaknesses in the organisation’s systems for monitoring clinical performance and improving the quality of its service.”

Furthermore, following the changes to the GP contract in 2004, Camidoc’s rapid shift from a small GP co-operative to a major provider of out-of-hours care left it ill-prepared to cope with its new responsibilities, it says.

The report makes several recommendations to better the quality of out-of-hours care, including that PCTs develop action plans to fully respond to its findings, and that they ensure that any questions about the practice of individual GPs are handled through “established mechanisms for maintaining the quality and safety of patient care.”

In a statement, Camidoc said: “We accept and will deliver all of the recommendations, many of which we are already in the process of implementing.”

Free NHS for all?

The debate over out-of-hours care will take another turn at the British Medical Association’s annual meeting later this month, when a group of GPs, led by Dr Andrew Green, will put forward their case for asking patients to pay for evening and weekend consultations.

Dr Green insists that that current service levels are not meeting needs, and that such a system would give patients the opportunity to make non-emergency appointments at times more convenient to them.

Explaining the rationale behind charging a fee of £15-£20 for each such consultation, he said: “We need to make sure that the costs incurred don't take money from other sources. They are going to be people in employment, almost by definition, and to ask them to bear the extra costs seems reasonable," reports BBC News Online.

But the suggestion that patients should pay to see their GP will surely spark outcry from those who insist that the NHS should remain free for all.