The concerns regarding 'Out of Hours' medical provision in the area warrant further comment.

Until recently, Family Doctors were responsible for providing medical care for twenty-four hours each day, 365 days of the year. In recent years they usually provided this care at night and at weekends using local doctors' cooperatives. However, The Government decided that with effect from early 2005, Family Doctors would only be responsible for providing a service from 08.00 to 18.30 on weekdays. At other times the Primary Care Trust would be responsible, not local doctors. When these changes were introduced there was a great deal of concern that the Government had significantly underestimated the cost of running such a service and that it would be unworkable both in terms of finance and also obtaining doctors.

In Worcestershire, in common with most other areas of the country, the Out of Hours service is staffed in three ways. A number of doctors are employed specifically for such work, some local Family Doctors agree to work shifts and agency locums are employed to make up the short-fall. The local doctors of both categories clearly have the advantage of knowing the local area and the staff at the Care Centre and Hospital.

Since the service was introduced, Worcestershire Primary Care Trust has twice reduced the number of doctors used to provide the Out of Hours service. The latest cuts mean that that there is no doctor based at Evesham overnight and only one doctor on duty at most other times. This single doctor has to cover Home Visits, patients coming to the Primary Care Centre and in-patients at the hospital. There are times when it is not physically possible for visits to take place within the statutory time limits. The lack of a round-the clock doctor at the hospital can only be described as downgrading the hospital by stealth making its future less viable.

When the current system began, a number of local doctors used to sign up for shifts but that has now almost stopped. I believe that one of the reasons involved is a concern about clinical safety. Unlike Dr Tim Davies, who seems to believe that the service is safe (Journal 19th January), the local doctors who have actually worked at the centre at Evesham appear to think otherwise. Moreover, as the system is less than one year old, why does it need to be continually modernised as Dr Davies claims is the case.

I suspect that the real truth is that inadequate government funding means that the Primary Care Trust simply cannot afford to deliver the service which it is legally obliged to provide. Just as in education, Worcestershire is under-funded. However, if this is true, it would be far better for The Primary Care Trust to admit that this is the case, rather than continuing to pretend that it is delivering a satisfactory service when this is quite clearly not the situation.

Adrian Hough, Evesham.