Lessons learned in out-of-hours care
7th June 2007
A successful out-of-hours care service relies on careful planning, a strong network of support for staff and a clear understanding of patient needs, explains John Harrison
Much has changed since Northern Doctors Urgent Care (NDUC) first started out as an out-of-hours care provider more than 10 years ago. Looking back, it’s hard to imagine a time where there were no quality standards to meet and all GPs were obliged to do out-of-hours shifts as part of their contracts.
The biggest change to occur in the field was undoubtedly the Government’s decision to hand control of out-of-hours services to PCTs in 2004. However, other significant developments, including the Carson Report in 2000 – which set new standards for out-of-hours providers – have also had a significant impact on how NDUC operates today.
A not-for-profit organisation, NDUC started its life as a GP co-operative in Northumberland, but restructured into its current form as a community benefit society after the PCTs took responsibility for out-of-hours. The group now handles out-of-hours care for patients in Northumberland, North and South Tyneside and Newcastle, with plans to expand out of the region.
Throughout its first decade, NDUC has learnt many lessons about what works – and what doesn’t – in out-of-hours care.
A streamlined approach
Prior to the new system under the PCTs, NDUC was over-staffed. Nowadays, the group is more streamlined, with fewer doctors and more operational staff, including clinical and training managers – all handling duties that were previously covered by GPs. Under this system, dedicated teams keep an eye on NDUC’s performance while the doctors focus purely on patients – a set-up that is both cost-effective and efficient.
In its earlier years, NDUC ran a host of different centres across the area it covered, each operating independently from the other. Today, the service is more tightly controlled, with all core staff being based at headquarters.
Focus on quality
NDUC keenly welcomed the Department of Health’s introduction of quality standards in October 2004, as they provided a solid benchmark for measuring the success of patient care. These requirements – such as making sure all home visits for urgent cases occur within two hours of a call – are easily met if simple procedures are in place.
For example, effective triage is vital if urgent cases are to be acted upon within these timeframes. A key difference between working as a doctor during standard hours and working an out-of-hours shift is the need to assess a patient’s condition over the telephone. GP training is very focused on face-to-face assessments, but out-of-hours doctors are often required to make an initial judgement without actually seeing a patient. As this can prove quite challenging, training is provided on telephone assessments.
During NDUC’s earlier years the training it offered was rather ad hoc, but these days the group provides specific training for registrars, from an ‘amber’ level where they’re closely supervised, through to a ‘green’ standard when they are ready to receive remote supervision.
The introduction of formal policies and procedures is another way in which NDUC has improved its services, reflecting a more forward-thinking approach to potential problems. In the past, the group had no clinical guidance in place, whereas now, there are guidelines covering a range of issues, from care of children through to contingency plans in case the telephones go down in its call centre.
Targeted recruitment
When recruiting staff, NDUC employs local doctors and nurses, which helps maintain its standards of quality, as it knows the surgeries they work for and is aware of their reputations. In turn, the doctors know the type of patients they’ll be dealing with and have an awareness of the referral strategies and care pathways used by NDUC.
A recent patient survey commissioned by NDUC showed that the vast majority of people preferred their out-of-hours services to be run by GPs. While nurses certainly play an important role in the provision of round-the-clock care, most patients would rather be seen by a doctor should they fall ill outside of surgery hours and so GPs form the majority of NDUC’s staff base.
However, NDUC works closely with district nurses on palliative care cases, exchanging advice on how to proceed with patients. Minor injuries nurses work at NDUC’s urgent care centres and the organisation provides them with help, including medical advice on specific cases.
The right balance
Offering care for patients outside standard GP surgery hours clearly has its own unique challenges, not least the need to keep an eye on both performance figures and the bottom line. Balancing cost-efficiency with a drive for high standards means that neither the patient nor the tax payer loses out.
It has good working relationships with its commissioners who have been supportive of NDUC’ s changes.
Over the past 10 years, NDUC has finely tuned its operations so that it consistently meets and exceeds the Department of Health’s targets, while offering a cost-effective service. It’s certainly been an interesting decade and the organisation hopes to build on its success and carry forward the lessons it has learnt to further improve its services in the future.
John Harrison is general manager at Northern Doctors Urgent Care
For further information please contact Nathalie Porter or Laura Foster at Admiral PR, on 0191 222 0722. Or email: nathalie.porter@admiralpr.com
To contact the NDUC team directly, call John Harrison on 0845 60 80 325
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 service when GP contracts changed in September 2004.
