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Out-of-hours services are the arrangements to provide access to healthcare in the United Kingdom at times when General Practitioner surgeries are closed; normally between 6.30pm and 8am, at weekends, at Bank Holidays and sometimes if the practice is closed for educational sessions. Most Out-of-hours services in Scotland and Wales are provided directly by Health Boards. In Northern Ireland they are provided by the Health and Social Care Trusts.〔(【引用サイトリンク】url=http://www.gpoutofhours.hscni.net )〕 In England they are commissioned by Clinical Commissioning Groups, usually working together, as the contracts often cover large areas. Out-of-hours providers in England must be registered with, and are regulated by, the Care Quality Commission. 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. ==The GP Co-operatives prior to 2004== Woodside Health Centre in Glasgow established a successful deputising service before 1973: “. . . twenty general practitioners group together to provide a highly organised system of out-of-hours health care … The telephone” (at the health centre) ” is permanently manned and the patients are not involved in the delays of a post office diversion system. In the evening the telephone is answered by an experienced registered general nurse who can give advice where it is appropriate. In the event of a visit being required the nurse is able to contact the doctor on duty by radiotelephone. . . . . The patient’s previous notes are readily available to the nurse in the health centre and can be passed on to the doctor on duty. . . . Control of the system is exercised by a sub-committee of the health centre committee of management. The system thus has the advantages of a commercial deputising service in allowing doctors to have adequate time off duty, but control is exercised from within the health centre.” The Royal Commission on the NHS in 1979 reported that commercially organised deputising services had grown rapidly over the last ten years and about one third of all GPs made some use of them. 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 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. A minimum of about 40 GPs were needed to set up a successful cooperative. In 1996 the G-Docs out-of-hours cooperative in Grampian became Scotland’s first out-of-hours general practitioner service, financed by 200 GPs who each paid a monthly subscription. 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. Carson's proposal for “A new model of integrated out-of-hours provision ... accessed by patients via a single telephone call, routed in the first place through NHS Direct and passed, where necessary, to the appropriate provider of out-of-hours services in that locality.” eventually developed into NHS 111 and influenced the formulation of the 2004 GP contract. Until the 2004 contract most GPs provided care for their patients outside those hours either themselves, or as part of a GP Co-operative. The total amount earmarked for Out of Hours duties including Night Visit Fees was an average of just under £6000 per GP per year. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Out-of-hours service」の詳細全文を読む スポンサード リンク
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