A new report has revealed that almost half of GPs have turned down out-of-hours work as a result of the high costs of medical indemnity cover and that the majority of GPs feel that out-of-hours services are not a high enough priority for the NHS.

The report, which polled both private and not-for profit GP providers, suggests that out-of-hours GP services have ended up being marginalised over the past decade, leading to a ‘chronic shortage’ of staff.

It also calls for an end to ‘perverse incentives’ in contracting and tariffs that the authors say currently inhibit working between GPs and hospital accident and emergency services.

GPs have complained about rises in medical indemnity fees to cover urgent care provision, which has led the British Medical Association (BMA) to lobby medical defence organisations to offer discounts to GPs working out of hours.

An innovative risk-sharing scheme was set up to tackle the problem in Wales, which led to an increase in GPs willing to take on out-of-hours work, but the system has not yet been adopted anywhere else.

The report’s conclusions are that medical indemnity providers should take into account the quality and performance record of the provider when looking to associate levels of risk for the provider workforce.

A spokesman for the Medical Protection Society (MPS) said that the nature of the case mix presented in out-of-hours cover is more likely to give rise to higher cost claims, so sufficient subscriptions must be collected to ensure that the organisation is in a position to meet the future costs of defending claims against members.

He added that Government should undertake a full review to consider what barriers stand in the way of uptake of out-of-hours’ work by GPs and what policy proposals might tackle these issues.