Is it safe to come out yet?
21st March 2007
GP out-of-hours (OOH) providers have certainly been attracting a lot of fire recently from various quarters. We seem to be responsible for increases in 999 calls, increases in A&E attendances, increases in GP salaries and probably increases in global warming and England losing the Ashes.
OK, the last two points may be exaggerated but, then again, some of the other calamities being placed at our door have been excessive.
As an example, it has been reported that one of the reasons 999 calls have increased is due to poor performance of GP OOH services. We checked with our local ambulance service and they have indicated that 999 calls started to increase long before the GP OOH contract changes in 2004. Various factors are involved, not least of which the proliferation of mobile phones, which is yielding multiple calls per incident.
What we at Northern Doctors Urgent Care (NDUC) find particularly disappointing is that all GP OOH services are being tarred with the same brush. There are a variety of organisations delivering GP OOH services, ranging from PCT provider arms, GP co-operatives, private companies, Ambulance Trusts and Social Enterprises such as ourselves. The concept of Social Enterprises in the NHS was championed by GP OOH Services long before the DH found them trendy.
The impression has been given to the public is that all GP OOH services are failing. That is not true. Certainly some are, but others, including ourselves, are definitely not - quite the opposite. We are doing very well: exceeding National Quality Standards for OOH;,working closely with our commissioning PCTs; providing support to local OOH District Nurses; and looking after primary care patients who present at local A&Es or call the local ambulance service. We have a low complaints rate, a strong clinical governance ethos, and our quality management systems have been audited to ISO 9001.
We welcome the new RCGP OOH Clinical Audit toolkit, although we already use this technique. Our local PCTs describe our service as excellent and believe that we provide the best possible out of hours GP service for local people.
It is impossible to assess GP OOH services without discussing money. Indeed the whole system in place today was driven by the changes in GP payments and responsibilities.
NDUC is not the cheapest OOH provider around but we do demonstrate that for a reasonable price you can provide a quality service offering and excellent value for money.
Over the last ten years, NDUC and its predecessors have witnessed dramatic changes to this often forgotten and, frankly, unloved part of the NHS. We have observed what has worked and what hasn’t. We have seen some PCTs - fortunately not the ones we deal with - under financial pressure, being seduced by knock down prices for the delivery of GP OOH services.
Unfortunately we have also seen the consequences of this. And quite often it doesn’t lead to lower costs when the combined cost of other local service providers, including A+E and in-hours services, is taken into account.
OOH services are capable of being clinically excellent, meeting standards, providing value for money and, most importantly, a quality service to patients. What the system just needs good commissioning, good management and not trying to screw the last penny out of the system.
John Harrison is General Manager of Northern Doctors Urgent Care
Notes to Editors:
Northern Doctors Urgent Care (NDUC) is an experienced and innovative provider of call handling and clinical services in the Primary Care sector. It provides call handling and clinical services and clinical triage either independently or as part of a full out of hours service to 934,000 patients in Northumberland, North Tyneside, South Tyneside and Newcastle PCTs in the North East as well as a number of other healthcare providers.
The service also offers urgent and routine appointments to local primary care centres and offers telephone advice on medical conditions and how to access out of hours pharmacy, nursing services and other NHS services.
Established 10 years ago as a GP co-operative in Northumberland, NDUC restructured in its current form in 2004 to support Primary Care Trust's when they took over the responsibility for GP out of hours services when GP contracts changed in September 2004.
