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BMJ. 2007 June 2; 334(7604): 1130.
PMCID: PMC1885319

Out of hours GP services are criticised after death of patient

Gordon Brown has said that patients need better cover from GPs at night time and weekends, after a report into a woman's death was published. The report criticised new arrangements for out of hours care, which, it said, led to confusion over exactly what level of care is expected outside normal practice hours.

Penny Campbell, from Islington, north London, died from septicaemia at the age of 41 at the end of the Easter bank holiday in March 2005, after she had had contact with eight doctors from Camidoc, an out of hours service provider to four boroughs in north London.

Camidoc commissioned an independent investigation into Ms Campbell's death, which has been overseen by a panel made up of representatives from Camidoc and the four primary care trusts that commission the service.

The panel's report found that Camidoc was ill prepared for the increase in its responsibilities that came with the government policy, introduced in 2004, allowing GPs to opt out of providing 24 hour cover for their patients.

The report calls for the Department of Health and the NHS as a whole to address the perception that an out of hours service is a “holding bay” for patients until their GP resumes care. “Policy confusion” over whether an out of hours service should provide urgent or unscheduled care also needed to be resolved, the report says.

Mr Brown, currently the chancellor of the Exchequer and soon to be prime minister, said, “The health service has got to be there for people when they need it, and we need to do better in the future.

“What I've been talking about is how we can extend the range of facilities for health care at weekends and out of hours. We need more access to doctors, we need drop-in centres, we need local healthcare centres to be more effective, we need NHS Direct to be working.”

Ms Campbell, who had one young son, had undergone a routine surgical procedure at the London Independent Hospital two days before the bank holiday weekend.

Over the weekend Ms Campbell had contact with eight doctors from Camidoc, none of whom recognised that she had septicaemia. On the morning of Easter Monday she decided to go to an emergency department but died at the Royal London Hospital the next morning.

The cause of death was recorded as multiorgan failure after septicaemia from a perirectal abscess that resulted from a sclerosant injection for haemorrhoids.

The inquiry into her death judged that the paper based record of consultations used by Camidoc, which meant that doctors could not easily access notes made on the previous doctors' visits, was a major system failure that had a direct effect on Ms Campbell. It concluded that just one of the eight doctors involved in the case had not provided a reasonable standard of care. It asked all the doctors to reflect on the case.

The health department said that Ms Campbell's death was not caused by changes in arrangements for out of hours care but occurred because her urgent need for medical care was not identified. “We have asked PCTs [primary care trusts] to review their arrangements for how clinicians relay information to each other and where necessary to change their contract arrangements with providers,” it said in a statement.

The report criticised Camidoc for failing to keep pace with modernisation in the NHS. Camidoc had been “a small organisation, set up as a GP co-operative that had grown rapidly in a short space of time,” the report said. It described Camidoc as “an inward looking organisation” with no clinical organisation strategy, a lack of vision, and no clinical governance plan. GPs had no contracts with Camidoc, and it did not verify the registration status of GPs who worked for trusts not served by the organisation.

The report also criticised Camidoc for not investigating the incident straight away “when memories were fresh” and for choosing to wait until after the inquest into Ms Campbell's death. The organisation should consider appointing a medical director who could lead the development of a robust and professional clinical culture within the organisation, the report concluded.

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.”

The chief executive of Islington Primary Care Trust, Rachel Tyndall, said, “There were failings in her [Penny Campbell's] care and [in] the systems to guarantee quality. The health service will respond to these.”


Articles from The BMJ are provided here courtesy of BMJ Group