Most pundits will agree with the Audit Commission that out-of-hours care is inconsistent in both its standard and availability across England.¹ Although this is old news, it is still failing and needs to be considered. The Department of Health published a paper in October 2006, titled “Direction of travel for urgent care: a discussion document”,² which outlines solutions to the problem. This is an important document that, apart from having a snippet of management-speak waffle in its title, needs serious analysis.

The College of Emergency Medicine and other groups with a vested interest in its content will understand that the proposals outlined (or something like them) will be pushed through, regardless of any feedback the government receives. Although we are in the consultation phase of the proposal, the government’s track record clearly indicates that the likelihood of them back tracking is remote, whether or not there is any merit, evidence of efficacy or even widespread opposition. Although there has been reversal of some policies emanating from the Home Office and the Department of Education, this is not so in health. PFI hospitals, Foundation Trusts, NHS Direct, Modernising Medical Careers, new employment contracts and the four-hour target are all testimony to this.

Once we get through the pious tone of the first few …