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THE DEBATE: Should private firms run; There's often conflict between welfare and profit.

AT ONE time, out-of-hours cover was provided by your GP or a locum hired by the practice.

With GP contracts changing and many of them opting out of out-ofhours cover, someone had to pick up the ball, and quickly.

So step forward the private companies like UC24, who have outbid and undercut local doctors' partnerships.

You could argue it should make no difference. As Deng Xiao Ping, Mao's successor, once famously said: "Who cares whether the cat is black or white so long as it catches mice?". But it does matter!

Some NHS money (our money) goes as private profit.

The NHS loses daily operational control of a key service.

Complaints cannot be pursued in the same way.

The workings of a privately owned out-of-hours service are commercially sensitive, poorly monitored by local NHS chiefs, and whistleblowers are gagged.

Locally UC24's call handling has been criticised both by medical professionals and patients.

Two doctors in Southport have resigned from their out-of-hours service as the only way they felt they could get their concerns taken seriously, after the local PCT commissioned UC24.

They felt UC24's assessment of cases was at times unsafe. Others have questioned the software being used and the training of staff. These mirror concerns heard elsewhere.

In Cornwall, Serco (who run our trains locally) provide out-ofhours doctors, and fly some in from abroad to fill the holes.

Details of their failings emerged only after a local newspaper used the Freedom of Information Act.

Confidence in how contractors are monitored is not improved when one observes how people working for the firms bidding can often be ex-employees of the NHS bodies giving out the contracts.

The relationship can be all too cosy and accountability limited. The same government that seeks to boost these private firms is setting up new bodies called Links to lobby on behalf of patients, but - guess what? - the new law will give them no right to inspect or check these private firms, and impose no duty on the firms to respond to complaints.

Working to a contract properly enforced with quality standards and tough penalties for poor performance, could improve matters.

BUT that does not alter the fact that you are replacing a service whose sole aim was patient welfare with an organisation whose objective is profit.

No contract, however cleverly written, can eliminate the possibility of conflict between those two objectives, which is why we created the NHS in the first place. Isn't it ?

NO Dr John Pugh, Lib- Dem MP for Southport


Concerns have been raised about the out-of- hours care provided by Urgent Care 24. Three Primary Care Trusts on Merseyside have given the organisation three weeks to bring the service up to basic national standards
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Publication:Daily Post (Liverpool, England)
Date:Mar 13, 2007
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