The Commons health select committee has warned that the NHS is not prepared for changes in GPs' out-of-hours care in England.

Under changes being introduced over the next few months, GPs can opt-out of seeing patients outside surgery hours.

Party Response: Liberal Democrats

Paul Burstow, Liberal Democrat health spokesman, said: "Patients need to know they will receive high quality services at whatever time they need them. They should not be faced with a minefield of confusing information, which requires a route map and compass to find access to the appropriate treatment.

"A lack of clear access to GP services could put patients at risk and overload struggling A&E departments. There are chronic shortages of key staff that are holding back the development of good quality healthcare closer to home. Unless more GPs are recruited, and the work is spread between other health professionals, we could see out-of-hours services struggling to cope in many areas.

"This report demonstrates that when it comes to out-of-hours care, the government is forcing the local NHS to tread a tightrope. Local health trusts are facing substantial risks in the current reform. The government must support the primary care trusts to make sure they can deliver safe, reliable care to local people."

Stakeholder Response: NHS Confederation

Dr Gill Morgan, chief executive of the NHS Confederation, said: "It will be a real challenge for PCTs to implement cover services, but this is an important step in the recruitment and retention of family doctors. This transfer of responsibility gives PCTs the opportunity to employ the skills of all healthcare professionals, not just GPs.

"PCTs are currently in a varying state of readiness for providing cover, but the necessary structures and support are available. Although a minority of PCTs may experience significant pressure in the run-up to the January 2005 deadline, we are confident that all PCTs will secure a safe and effective service for patients.

"The new contract is about doing things differently, not more of the same. Communication to both patients and other sectors of the NHS is vital during the transition period, and we strongly support both national and local campaigns to encourage this. Overall, the new GMS contract will enable PCTs to design more joined-up services, give GPs a more manageable workload, and benefit patients through an improved standard of care."

Stakeholder Response: Royal College of Nursing

Liz Hewett, executive director, service delivery, of the Royal College of Nursing said: "The Royal College of Nursing supports the aim of reducing GP workloads as long as the proposed service reflects the needs of patients. It's important that the health committee has recognised that nurses are ideally placed to provide out-of-hours services.

"However we have real concerns about the potential impact on NHS Direct being expected to meet the increased demand as a result of GPs opting out of out-of hours cover. Expansion in NHS Direct provision must not be allowed to negatively impact on the quality of service provision.

"We welcome the opportunity for PCTs to balance emergency and out-of-hours services within their locality. However, we have similar concerns to the health committee that changes to any emergency service will simply increase the demand in other parts of the NHS and put pressure on an already stretched service.

"The way forward is a multi-professional approach with clinical teams having access to a GP when necessary.

"PCTs need to think differently about workforce planning with the most appropriate clinician providing the services to patients. With the right support nurses can take on advanced practice roles and contribute to out-of-hours services. PCTs could usefully revisit their assumptions of the role nurses and other healthcare workers can play.

"We urge the government to ensure that PCTs involve nurses in order to guarantee high quality services for patients."