DH - Greater improvements to GP out of hours care - 4 Feb 10

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GPs providing out of hours care in England will be subject to tighter controls and more robust skills and knowledge testing, Health Minister Mike O’Brien announced today.

These tough new measures form part of a package that together with stronger national standards and tighter monitoring of performance will improve GP out of hours services.

The measures follow a report ‘General Practice Out of Hours Services’ published by the Department of Health today. The Department has accepted all of the report’s 24 recommendations and expects all Primary Care Trusts (PCTs) to act on them as a matter of urgency.  PCTs have already been issued with interim guidance to assist them in complying with their obligations to ensure all doctors admitted onto their list of approved out of hours GPs have a satisfactory knowledge of English.

Today’s measures will go even further, introducing stronger national minimum standards and producing a model contract for PCTs to use when procuring out of hours services.  We will consult on the content and expect it to be in place by the end of the year.

The Department will also look to GPs for input on how local out of hours services meet the needs of their local communities.

PCTs will also be expected to regularly review their performance management arrangements for their out-of-hours GP services, ensuring they are robust and fit for purpose.  Strategic Health Authorities should also oversee how PCTs manage the performance of out of hours GP providers.

Health Minister Mike O’Brien said:

• “I extend my condolences to the family of Mr Gray. Patient safety must be a top priority of the NHS.  Although out of hours services are much better than before 2004, some PCTs are not meeting their legal obligations and I am determined to tackle this.
• “I am accepting all the recommendations made in today’s report and setting out new measures that go even further. These will tighten existing controls and ensure that out of hours providers are employing competent clinicians, providing safe and effective care.
• “I expect all PCTs to act on these recommendations as a matter of urgency. It is unacceptable for any Trust to fail to meet its obligations on safety and quality of care.
• “By April 2012 every provider of GP healthcare, including out of hours providers, will need to be registered with the Care Quality Commission and will be subject to checks on compliance.”

RCGP Chairman, Professor Steve Field said:

• “Regardless of where they live patients must feel confident that they are receiving high quality care out of hours. There are examples of excellent Out-of-Hours services around the country but as recent events have shown, there are areas where care is not as good as patients deserve.
• “We’re pleased that Minister of State Mike O’Brien has accepted our report in full and that the Government is taking the right steps in ensuring that patients will receive consistently good care across the country.”

The report, conducted by Dr David Colin-Thome, National Clinical Director for Primary Care at the Department of Health, and Professor Steve Field, Chairman of Council, Royal College of General Practitioners was commissioned by Mike O’Brien in October 2009 and looked at current arrangements for out of hours services.

It found that there are already robust requirements in place to ensure the commissioning and delivery of safe, high quality out-of-hours services, but there is unacceptable variation in how these are implemented and monitored by Primary Care Trusts around the country.

Notes:

   1. The full report contains 24 recommendations in total. It can be found at www.dh.gov.uk
   2. The report outlines a number of recommendations to improve the commissioning and provision of out of hours care including that:

• Primary Care Trusts should review the performance management arrangements in place for their out-of-hours services and ensure they are robust and fit for purpose;
• The Department of Health should issue guidance to Primary Care Trusts to assist them in making decisions about whether or not a doctor has the necessary knowledge of English;
• The Department of Health should develop and introduce an improvement programme for Primary Care Trusts to support their commissioning and performance management of out-of-hours services;
• Out-of-hours providers should consider the recruitment and selection processes in place for clinical staff to ensure they are robust and that they are following best practice in this area;
• Strategic Health Authorities should consider how they monitor action taken by Primary Care Trust in response to this report and in carrying out appropriate performance management of out-of-hours providers; and
• Providers should co-operate with other local and regional providers (both in and out-of-hours) to share any concerns over staff working excessive hours for their respective services.

 3. The out of hours period generally refers to:
(a)   the period beginning at 6.30pm on any day from Monday to Thursday and ending at 8am on the following day,
(b)   the period between 6.30pm on Friday and 8am on the following Monday, and
(c)   Good Friday, Christmas Day and bank holidays.

   4. By the Beginning of 2004, approximately 70 per cent of GPs had delegated the responsibility to a GP co-operative, and around 25 per cent to a commercial provider.  By April 2005, 75 per cent of out-of-hours provision was carried out by the Trusts themselves or through co-operatives, with the remaining 25 per cent provided by commercial providers, ambulance trusts and others, and with NHS Direct supplying initial call handling for many providers.
   5. NHS Chief Executive David Nicholson will be writing to PCTs to remind them of their legal obligations and to urge them to implement the recommendations in the report.
   6. For more information please contact the Department of Health press office on 020 7210 5221.

Related Items:

• DH - GP out of hours services: letter from David Nicholson - 4 Feb 10
• BMA response to out-of-hours report - 4 Feb 10
   

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