A GROUP of GPs has warned that it may be forced to pull out of a successful pilot to keep Kendal's emergency unit open 24 hours a day, reports Michaela Robinson-Tate.

The doctors claim hospital bosses have failed to deliver the improved accommodation that they badly need. A GP who works in the unit said they were forced to sleep in a converted toilet, and their rooms were isolated, leaving staff feeling vulnerable.

If the GPs pulled out of the pilot next month, hospital chiefs said they would probably be forced to look overseas to find doctors to run the unit.

However, all the health service bosses involved have pledged to keep the unit running. MP for Westmorland and Lonsdale Tim Collins has offered to contact government ministers to seek a commitment to funding building work.

The pilot was launched in October 2002 in response to severe staffing problems at the emergency and minor accident unit (EMAU), including a shortage of doctors and nurses. The difficulties had put round-the-clock opening at risk.

In a bid to solve the problems, GPs from the Westmorland Primary Care Co-operative, who already had a base at Westmorland General Hospital, agreed to see some patients at the unit between midnight and 8am.

A group of GPs, and hospital and health service managers, who met to review the pilot's half-way stage, reported the experiment had worked well.

However, the co-op's medical manager, Dr Sally Reeder, said accommodation, which had been an issue for five years, was still a stumbling block.

She told the meeting how the co-op occupied different offices at different times of day and night which made communication and information technology use very difficult. They did not have space to expand, and needed consulting rooms and improved offices.

Upgraded bedroom accommodation for the GP on duty, which had previously been controversial, was only a small part of what was required, she said.

Dr Reeder told the meeting: "Everybody was quite despondent we had hit the three-month stage and felt this was back at stage one."

She said the co-op did not want to pull out: "We need this accommodation to provide the type of out-of-hours care for the patients which is required. We don't want it to all fold but it's not just as a means to an end of getting nicer rooms and a nicer bedroom."

Kendal GP Alistair MacKenzie warned the doctors wanted a commitment on building work.

"We are sleeping in a converted single toilet at the present with the smells associated with that. I think the GPs will walk away if there's not a clearly labelled time scale of how it's going to be done."

Graham Smith, deputy chief executive of Morecambe Bay Hospitals NHS Trust, which runs the unit, said there was a need to "tweak" the bedroom accommodation, which was not intended to be permanent.

Plans already discussed to expand into a courtyard to provide GPs' office and restroom space could cost up to £70,000. The trust needed guidance from Morecambe Bay Primary Care Trust which would commission and fund any scheme - on whether this amount should be spent when there were larger plans in the offing, he said.

The plans were for an integrated unit with a single point of entry for out-of-hours and unscheduled hospital attendances, which could cost three-quarters of a million pounds. The courtyard scheme was still "on the table", but hospital bosses did not want it to be made redundant, and the money therefore wasted.

Speaking afterwards, Mr Smith said if the GPs pulled out, trust bosses might be forced to look overseas for doctors to man the unit, as they had done previously.

PCT director of strategic development Caroline Rea said progress was possible.

February 7, 2003 09:30