From next month, providers of out-of-hours services will have a new set of standards to comply with. Dr Gerard Panting explains what this will mean for GPs
Gone are the days when GPs were obliged to take responsibility for their patients’ care 24 hours a day, 365 days a year. The new primary care contracts introduced earlier this year allow GP practices to opt out of out-of-hours care and pass the responsibility for ensuring that patients have access to 24-hour care to the primary care organisation.
Since November 2002, all organised providers of these services have had to comply with quality standards set down by the Department of Health. These are now to be replaced by national quality requirements in the delivery of out-of-hours services, which will come into effect on 1 January 2005 (Box 1, below).1
|Box 1: National quality requirements in the delivery of out-of-hours services|
There are four models for delivering out-of-hours services:
- The PCT commissions services direct from providers (APMS), which must comply with the quality requirements and report regularly to the PCT on their compliance with them.
- The PCT provides its own out-of-hours services (PCTMS). The PCT must comply with the same requirements as the model above, so the part of the PCT that provides the service will be required to report regularly on its compliance to a different part of the PCT that is responsible for the quality of services.
- The practice provides its own out-of-hours services. These practices will also have to comply with the quality requirements and report on their compliance in the format agreed with the PCT. This is an acknowledgement that detailed reporting as required of other providers would be too onerous for individual practices, and PCTs should ensure that they do not impose too burdensome a regime on the practice.
- The practice subcontracts its out-of-hours services direct to another provider, in which case, the GP practice itself is responsible for meeting the quality requirements. Practices can enter into their own arrangements only with the agreement of the PCT, and again, the PCT and practice will have to agree on exactly what regular reports should be made to the PCT.
National quality requirements
The 13 requirements listed in the Department of Health’s paper (see Box 1) put in place performance measurement of out-of-hours services and, with the exception of reporting requirements, will apply to all four types of arrangements of out-of-hours services.
The requirements set out a number of standards designed to promote continuity of care. These include giving the patient’s usual practice details of any out-of-hours consultation by 8 am the next working day and coordinating with out-of-hours providers over the care likely to be needed by particular patients.
Next, the requirements stipulate that patient experience must be audited regularly and action taken on the results. This may appear onerous, but audit should be undertaken by the provider’s administrative staff and not increase the workload of clinical staff.
All providers of care to NHS patients must have a complaints procedure in place, so anyone providing an out-of-hours service should already comply with requirement 6.
As patient demand varies from day to day, resource requirements fluctuate. The DoH document recognises that although these fluctuations are predictable – for example the third day of bank holiday weekends and Saturday and Sunday mornings are invariably busier – providers are expected to anticipate periods of peak demand and staff the service to meet the urgent needs of patients that cannot safely be deferred until routine service is resumed.
Requirement numbers 9-12 are all about ensuring that patients who require urgent treatment are suitably prioritised, including being seen by the clinician best equipped to meet their needs in the most appropriate location – obviously, including the patient’s home.
Requirement 13 seems aptly numbered, requiring as it does the provision of an interpreter within 15 minutes of initial contact for any patient unable to communicate in English. This seems an impossible target to set, requiring virtually instantaneous access to interpreters for every language on earth.
Performance measurement and management are common practice in virtually all types of enterprise and clearly can be very constructive provided care is taken to measure the right things. Looking at the burden placed on out-of-hours providers, many GPs who no longer have this responsibility may be heard to take a deep sigh of relief.
- Department of Health. National Quality Requirements in the Delivery of Out-of-Hours Services. London: DoH, 2004.