The contract for General medical services which most GPs work to requires practices to be responsible for their patients between 8 am and 6.30 pm from Monday to Friday.
In some cities commercial deputising services were set up employing doctors to cover the out of hour’s period, paid by the practices in the area but these weren’t viable in much of the country.
They received complaints that deputies lacked personal knowledge of the patient and access to the medical records, contacting the service could be difficult, and that deputies were slow in responding to emergencies[4] In 1994 after minor changes to the GP contract many groups of doctors got together and formed cooperative organisations sharing the out of hours calls between a large number of GPs on a rota basis.
[5] The Carson Report published by the Department of Health in 2000 proposed quality standards which would apply not only to deputising services and Out-Of-Hours cooperatives but also to individual GPs & practices providing their own cover.
[7] The total amount earmarked for Out of Hours duties including Night Visit Fees was an average of just under £6000 per GP per year.
Some PCTs worked with the GP co-operatives, but some gave the contract to a commercial provider, commonly Harmoni or Serco both of which have been the subject of major complaints and of failing to employ sufficient doctors.
[12] David Cameron introduced plans to enable "hard working people ...to see their GP seven days a week and out of office hours" in September 2013.
This promised access to GPs from 8am-8pm, and on Saturday and Sunday and to "test a variety of forward-thinking services to suit modern lifestyles, including greater use of Skype, email and phone consultations for those who would find it easier.
[15] In April 2015 Exeter Medical School used data from the official GP patient survey in England to score different types of providers out of 100.
[18] It runs out of hours services in Rotherham, Hampshire, Harrow, Hillingdon, Merton, Islington, Kingston, Wandsworth, Camden and Ealing.
[20] Nestor Primecare Services Limited provided out of hours services in Mid Essex, Dudley, Sandwell, Heart of Birmingham, South Birmingham, Wolverhampton, Herefordshire, Scarborough, Sunderland in England and Abertawe Bro Morgannwg and Carmarthenshire in Wales but withdrew from its contracts in November 2018.
Urgent Health UK is a federation of Social Enterprise Unscheduled Primary Care Providers to which many of these organisations belong.
In February 2017 Pulse (magazine) reported that 10 of 104 providers who responded to a Freedom of Information request admitted that there had been overnight and weekend shifts over the past year with no GP cover.
[26] In June 2019 it was reported that the service at Vale of Leven Hospital had been closed 50 times since December 2018 as no GPs were prepared to work.