Health ministers want to establish a single national telephone number to summon out-of-hours help from a GP, instead of local services of variable speed and quality. The national service would aim to provide an almost instant assessment of a patient's needs, leading to advice over the phone for minor ailments, an out-of-hours visit by the patient's GP or locum for more serious conditions, or a rapid response from an ambulance to accidents or emergencies.
The first step will be taken today by John Denham, the health minister, when he accepts a report from a team led by David Carson and Ian Trimble, GPs from east London and Nottingham.
It calls for an amalgamation of services offered by the telephone advice line NHS Direct, local GPs and other services such as accident and emergency. The report suggests different areas could experiment with different models of integration, depending on local strengths.
In some areas GPs might want to continue to provide most out-of-hours care for their patients, while in others there might be greater use of locum services. But in each case the patient would call a single hotline and be directed to the appropriate service.
Mr Denham is expected to accept a recommendation for national targets, including 90% of calls answered in 30 seconds and all patients getting the care they needed within a maximum of six hours. Patients should also always be told how their call was being looked after and when they could expect to be seen.
The report follows concern among ministers about large variations in speed and quality of out-of-hours services. A health department source said: "Some parts of the country have good, consistently fast and popular ways of doing this; in others there are networks of answering machines which are slow and frustrating for patients."
The health service ombuds man, Michael Buckley, warned in June of "totally unacceptable" performance by the biggest of the private companies providing a deputising service for GPs outside working hours.
Defects in the service offered by Healthcall for 7,500 GPs included insufficient training for call-handling staff and inadequate procedures for prioritising calls. The company promised to address these weaknesses.
Mr Denham is expected to tell the National Association for Primary Care conference in Harrogate, North Yorkshire, that the government will sponsor local experiments in integration over the next year. Financial support would be available if needed. The scheme would not amount to a takeover by NHS Direct. There would be no threat to successful schemes such as the GP cooperative offering out-of-hours care in west London.
The health department ex pects support from GPs who are willing to attend patients at night in cases of real need, but dislike making pointless visits. Ministers think this could be achieved by better trained assessment of callers' requirements.
