Doctor's orders

For years, North Yorkshire has been blighted by manpower shortages

which were described as exceptional. Regrettably, this is no longer the case. These glitches, which pose a clear threat to the welfare of patients, are now commonplace.

Scandalously, there have been occasions when there were two "on call" doctors to cover Sheffield's 530,000 citizens at night. It's little better in West Yorkshire where care has been compromised by

deficiencies in the communications equipment at the disposal of medics.

Most tragically of all, the gross negligence of a German locum doctor directly caused the death of 70-year-old David Gray in Cambridgeshire after he was injected with 100mg of diamorphine – 10 times the recommended daily dose.

If his local doctor had been available on the fateful night in

question, Mr Gray would almost certainly be alive today. Instead, there are huge variations in the quality of night-time cover – yet another postcode lottery – with doctors being shipped in from abroad, following minimal checks on their competence, to work in areas that they do not know, and without access to patient files. Some even have a limited command of the English language.

This must stop. The question, however, is how this can be achieved.

Everyone wants to see their local doctor. However, in plain terms, GPs cannot be expected to be available 24 hours a day, and for 365 days a year. It simply is not feasible, hence the onset of region-wide "on call" services.

Yet, having seen their pay improve vastly under New Labour, some would argue – legitimately – that they have an obligation to provide more robust care arrangements than at present in return for better pay. As such, it is up to them, and Primary Care Trusts, to devise, and implement, a minimum set of standards that are far superior to the present after-hours arrangements.