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Sunday 27th May 2018

NAO Report on Out of Hours Care

5th May 2006

05052006_maninpainQ.jpgThe National Audit Office (NAO) has released its report 'The Provision of Out-of-Hours Care in England'. The report concludes that 'there were shortcomings in the process of setting up new arrangements to provide out-of-hours primary medical care in 2004, although there is no evidence that patient safety was compromised'.

The Primary Care Trusts (PCTs) who took over responsibility for organising out-of-hours services from GPs lacked knowledge and experience in this area. However, most patients say that they are receiving a good service, with six out of ten rating it as excellent or good.

No providers are meeting all the required levels of performance and few are achieving the required levels for speed of response, but the report finds that, after some initial problems, the service is beginning to reach a satisfactory standard.

It also finds that the actual costs of providing out-of-hours care under the new system are considerably more than the specific Department of Health allocation made to support these services, but says that there is scope to reduce costs without compromising quality. The NAO’s analysis shows that if all Primary Care Trusts were as good as the best performers, a saving of £134 million a year could be achieved without compromising quality.

In 2004 the Government responded to concerns that the system of GP responsibility for organising out-of-hours services was not sustainable, offering GPs the chance to pass on their responsibility to Primary Care Trusts. Most GPs did so during a period from April to December 2004. By April 2005, 75 per cent of out-of-hours provision was being carried out by the Trusts themselves or through co-operatives. The remaining 25 per cent went to commercial providers, ambulance trusts and others, and with NHS Direct supplying initial call handling for many providers.

Fewer than 10 per cent of PCTs who responded to the NAO’s survey are meeting the speed of response targets - that a clinical assessment should be started within 20 minutes of a call for urgent cases and within 60 minutes of a call for non-urgent cases; although the service is now beginning to reach a satisfactory standard.

Some PCTs are still confused over whether the out-of-hours services should be restricted to urgent cases or should respond to any request for medical care outside normal working hours, although there is no evidence patient safety is being compromised, says the report.

A survey conducted for the report suggests that patient experience is generally good. Eight out of ten patients are satisfied with the service, while six out of ten rate the service as excellent or good. During the out-of-hours period, the majority of patients (six out of ten) are seen within two hours and many (four out of ten) are seen in less than one hour.

Sir John Bourn, Head of the NAO said that the Department of Health is now on track towards providing high-quality out-of-hours services. However, he added, 'it is disappointing that there were so many problems in starting the new arrangements'.  He expressed concern that so few providers are meeting their targets for the time it takes to respond to patients, concluding that the continuing confusion over whether out-of-hours is supposed to be an urgent or unscheduled care service should be dispelled without delay.

Chairman of the public accounts committee, Edward Leigh, commenting on the report said that the new way of providing out-of-hours medical care has so far been 'a costly mess that has left many sick people waiting too long for help' reported the BBC.

Lord Warner, Public health minister, said officials would work with the NAO to improve the efficiency of evening and weekend cover, stressing that the old system was unsustainable. He added that PCTs would be told to draw up action plans for improvements and offered "master classes" to ensure they grasp the changes needed.

Jo Webber, of the NHS Confederation, said that 80% of patients were satisfied with the service, adding that PCTs were learning rapidly from experience gained during the first year of commissioning and that the report would help that process.

Chairman of the BMA’s GPs Committee, Dr Hamish Meldrum, said that the previous out-of-hours service was unsustainable. He said it was no surprise that the NAO found that the costs of providing out-of-hours services were higher than the government anticipated, as the BMA has been telling governments for years that GPs had been subsidising out-of-hours care from their own pockets to a very significant degree.

He added that patients deserve high quality services outside normal surgery hours as well as within those hours, and that 'it is worrying that, in places, quality targets such as response times are not being met.' He concluded that better integration of services and planning is needed, particularly in anticipating peak demand times.

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Gloria Stevens

Sunday 13th August 2006 @ 21:50

On recent occassions it has been necessary to call NHS direct, a wait of almost 3 hours is too long to wait when a patient is in severe pain. The advice given is usually in line with the patients own thoughts and I have found the service very unhelpful.

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