An investigation by the Daily Mail has revealed that four NHS trusts have more nurses than doctors covering out-of-hours care overnight.

The reporters questioned all PCTs and found that a further seven primary care trusts (PCTs) had equal numbers of doctors and nurses covering out-of-hours overnight care – and in some areas, as many as 330,000 patients are covered by just one doctor at night.

In 2004, the Labour Party allowed around 90 per cent of GPs to opt out of care at weekends and in the evening.

As a result, PCTs were forced to hire locum doctors, many of whom come from overseas and may not have sufficient language skills to practise. 

In 2008, 70-year-old David Gray died after a German doctor working for a company that covered out-of-hours care in Cambridgeshire administered 10 times the dose of diamorphine required to control his pain.

A subsequent investigation found that Dr Daniel Ubani – originally from Nigeria – had previously been turned down for work at one PCT because of his lack of English language skills. Dr Ubani was on his first shift as a locum in Cambridgeshire when he administered the fatal dose. In February, a court found that Mr Gray had been unlawfully killed.

The Mail investigation estimated that, in some areas, the chance of receiving a home visit from a doctor out-of-hours could be as low as one in 50.

Nurses are now more highly trained than they used to be, argue PCTs – and have been given prescribing powers under Labour.

However, the Mail investigation found that, in Derbyshire, just three doctors and seven on-call nurses were covering a population of around one million for both Derby City and Derbyshire County PCTs.

The PCTs countered criticism by saying that, on an average out-of-hours shift, 151 calls are received, resulting in 20 home visits. A total of five nurse practitioners see patients ‘face-to-face’, while two nurse advisers man the phones.

Between 2002 and 2008, complaints about out-of-hours care doubled from 120 to 241 annually. From 2007 to 2008, there were 75 complaints about patients dying and 17 lawsuits.

Many trusts may use nurses rather than doctors for out-of-hours care because it is cheaper. The Mail investigation found that, while some PCTs spend £15 per patient on out-of-hours care, others spend as little as 57p per patient.

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