There are three major disconnects causing problems with the quality of out-of-hours care provision (outside funding and staffing levels] that call on GPs to provide leadership. In the long term, GPs working exclusively in out-of-hours care shouldn't be revalidated as GPs unless they demonstrate keeping up to date with chronic disease management. Equally GPs mainly working in hours can be challenged by unscheduled care shifts. An out-of-hours session in is not equivalent to one in hours.Disconnect two: no coherent clinical governance. Some private' companies delivering out-of-hours care are designated bodies with their own responsible officers. However, most require their GPs to be on a performers list which will have its own responsible officer taking priority for their revalidation: why? Within many out-of-hours providers there are no regular peer-to-peer meetings to discuss significant events. Confidentiality clauses also stymie transparency. The report by Colin-Thome & Fields on general practice out-of-hours services in England noted supervision of out-of-hours GPs was mainly through medical directors and indeed urged commissioners to separate discussions on service delivery from quality with providers to maintain focus.
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