Tuesday, May 09, 2006

Out-of-Hours Care in England - NAO report

UK National Audit Office press notice - The Provision of Out-of-Hours Care in England

This report from the National Audit Office was released at the end of last week following an investigation into the provision of out of hours care in England, following the changes which made Primary Care Trusts (PCTs) responsible for this service in 2004.

The NAO found that after initial problems, "The service is now beginning to reach a satisfactory standard but no providers are meeting all the requirements and few are reaching the requirements for speed of response".

"The total cost for the first full financial year of arrangements was £392 million, 22 per cent more than the £322 million allocated by the Department", and potential savings can be made.

Various comments are made in the report about Information Management, reporting and call handling systems and their effects on the quality of the service , which have lessons more widely

The report found that GP pay rates for delivering out-of-hours care varied widely from an average of £58. 60 per hour to £107 per hour for a weekday evening. Rates on public holidays varied from a minimum of £48 per hour to £165 per hour, although I couldn't find any correlation between this and the care provided.

The contracting process was criticised with many being signed late or not at all, with significant legal implications. This was due to poor service specifications, disagreements between commissioners and providers over risk-sharing, and the inability to reconcile PCTs limited budgets with providers estimated costs of meeting all the Quality Requirements. Edward Leigh, the chairman of the public accounts committee, concluded that the change in arrangements for out of hours care as "a costly mess".

Amongstrecommendationsomendadtions is an expectation that the Department should also clarify the term "definitive clinical assessment" and this is just one example of the changeoccurringare occuring. This, along with general confusion about the role, size, function etc of PCTs, is likely to see the rise in private sector involvement in primary care.

A local example for me, is the emergence of companies such as GP care which has recently been created to provide primary care services. It includes the vast majority of GPs and health centres in the Bristol area as partners, and describes itself as "an entrepreneurial and innovative organisation which will compete effectively in the UK health market", while maintaining ethical principles; not seeing the maximisation of profit as the only marker of success, but also contributing to the common good by improving the health care of the people they serve.

It will be interesting to see how these changes will play out and whether the end result will be better care for the population?

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