03.10.14
Concern over NHS 111 omission as CQC praises GP out-of-hours services
The Care Quality Commission (CQC) has found “excellent” examples of practice in NHS GP out-of-hours (OOH) services, but identified “variation” in the quality of safety and care, under the regulator’s revamped performance regime.
And although the British Medical Association’s (BMA) GP Committee welcomed the findings, it was concerned about the omission of NHS 111 in the CQC’s report, which it believes must also be subject to inspections given “it is the front end telephone service for patients calling out of hours”.
Dr Chaand Nagpaul, chair of the BMA GP Committee, said: “NHS 111 continues to provide a variable and often inadequate call handling and triage system, and will impact on the ability for GP OOH services to provide optimal care.
“We believe that call triaging should be handled by experience clinicians, not non-medical staff. There is also a pressing need for greater integration across the urgent care pathway to include walk-in centres, ambulance services, A&E units and social care. Failure to do so is to give a partial rather than a true picture of out of hours care for patients.”
The CQC inspections gave the regulator the opportunity to look at progress against recommendations made in a review commissioned in 2010 by the Minister for Health, following high-profile failures in OOH services.
The CQC’s report concludes that there has been progress, including improvements in commissioning and performance management of GP OOH providers, since the 2010 review, but that there is still “some room for improvement”.
The 30 services inspected by the CQC, between January and March 2014, are run by 24 organisations and provide OOH care for approximately 36% of the population in England; some 19 million people.
Good practice found during the inspections included that most of the providers regularly monitored the quality of care they provided; there were fewer locum GPs covering shifts than expected; and some providers had developed innovative and responsive care as a result of feedback from patents.
But variation in the quality and safety of care highlighted that some providers did not have safe mechanisms in place for storing and checking the stocks of medicines held, and recording controlled drugs; didn’t have appropriate recruitment processes in place; and failed to inform patients on how they could make complaints about the service.
Professor David Colin-Thomé, a member of NHE’s editorial board, who was the independent chair of CQC’s review of out-of-hours GP services, said: “We have been impressed by the good quality of most of the GP out-of-hours providers visited.
“GP OOH services are frequently subject to unwarranted criticism. This report taken together with the recent National Audit Office report provides evidence to repudiate much of that criticism. As in all healthcare services of course, high quality is not uniform, and we have identified good and sometimes not so good performance.”
The regulator added that this is the first step in its approach to assessing the quality of urgent care more broadly. In the autumn it will be expanding its inspections to cover a wider range of urgent care providers, including NHS 111.
Dr Mike Bewick, deputy medical director at NHS England, said: “Patients need a consistent, high quality service in and out of hours and the feedback from this report is encouraging. Where variations and inconsistencies have been identified, I am pleased that action has been taken to put improvements in place.
“It is important that Clinical Commissioning Groups [which commission around 90% of OOH services in England] and GP services look at the many good examples of excellent practice across the country alongside ongoing feedback from their patients, to drive improvements.”
(Image: c. London Ambulance)
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