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HMRC internal manual

VAT Health

Doctors: Background to out-of-hours cover

Since 2004, responsibility for ensuring there is ‘out of hours’ cover lies with the PCT rather than the GP practice, although in some areas, practices have chosen to contract for this work. Accordingly, in most cases, payment for the out of hours services will be made by the PCT. In the main, out of hours calls are channelled, in the first instance, to NHS Direct, although they could be outsourced to other service providers. Provision of this service is becoming increasingly fragmented.

In most cases, the call-centre staff are nurses who use computer-aided decision making systems to determine the most appropriate course of action, which could range from calling an ambulance, asking the patient to make their own way to A&E, arranging for a doctor to call, or giving advice on self-care. They will resist referring to a doctor any calls that don’t require a doctor’s intervention. Accordingly, the service often involves triage assessment and signposting to other health services.