Taxpayer faces extra £70m bill for GPs' out-of-hours work

Reform of GPs' out-of-hours services will cost the taxpayer £70m more than anticipated this year, but there is no evidence patients are receiving better treatment, a National Audit Office report says today.

The Department of Health, already facing a deficit that could top £1bn, allocated £322m last year to introduce a system that is costing £392m, a miscalculation of 22%.

Meanwhile GPs, who can earn up to £250,000, and earn £100,000 on average, receive up to £165 an hour if they work out of hours - and are able to dictate high pay rates in areas where there are few family doctors, the spending watchdog says.

The NAO's report paints a picture of a system that was introduced with too little preparation, in April 2004, and is only "beginning to reach a satisfactory standard".

Around half of all primary care trusts are monitoring whether they meet the government's targets but of those who do, only 15% are managing to see emergency cases at their centre within an hour, and 13% are seeing urgent cases in patients' homes within two hours.

A mere 8% of patients deemed urgent get to speak to a doctor for an assessment within 20 minutes of making a call.

A Mori poll conducted for the NAO also found 35% of patients have to wait more than an hour for their call to be returned, and one in five patients is dissatisfied. The report notes that "no providers are meeting all the required levels of performance and few are accepting the required levels for speed of response".

The new system was hammered out as part of the GPs' contract with the aim of making general practice more attractive to doctors. It allowed GPs to opt out of providing out-of-hours cover, an option taken up by 90% of GPs. Many then opted back in, and now earn up to £107 an hour for a weekday evening, and up to £165 an hour on public holidays. Even those receiving average pay - of £74.30 an hour for a weekday night or £79.60 an hour for a weekend night - can receive nearly £1,000 for a shift.

The report describes doctors' pay as the "key driver of costs", and notes: "Many PCTs ... felt their finances were at the mercy of whatever pay rates GPs demanded."

It stresses there was confusion about how much GPs would cost. Under the new contract, £6,000 was docked from the salary of GPs who opted out, although the Department of Health calculated it would cost £9,500 per GP to replace them. In reality, it has cost £11,590 per GP.

The report says there is no evidence that patient safety has been compromised, but Chris Shapcott, director of health value for money studies at the NAO, admitted there was evidence of delays. The Department of Health said all PCTs would be required to draft action plans to improve performance. It stressed that if all PCTs were as cost-effective as the best, they could cut costs by over £100m.