BMJ 2014;349:g4591 doi: 10.1136/bmj.g4591 (Published 14 July 2014)
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News
NEWS NHS England is criticised for failing to robustly oversee out of hours care Gareth Iacobucci The BMJ
A senior MP has warned of a “serious governance failure” in the monitoring of GP out of hours services, after an official audit found that NHS England was failing to adequately monitor the variation in quality and value for money being achieved across the country.
of people had not heard of out of hours GP services. It said that those unaware of the services were more likely to go to accident and emergency departments or call 999 unnecessarily, and it said it was important that NHS England implemented its vision to integrate urgent and emergency care services in the future.
The report noted that, while some commissioners were achieving value for money with their spending on out of hours GP services, this was “not the case across the board.” It also criticised NHS England for taking a year to issue guidance to its 27 area teams about how to seek assurance on out of hours services, and it questioned whether the current monitoring arrangements were fit for purpose, as clinical commissioning groups were required only to answer a few “yes/no” questions.
It noted that 66% of patients in the recent GP patient survey were positive about their experience of out of hours GP services,2 but it highlighted “significant geographical variation.” It also estimated that out of hours GP services cost less now in real terms than in 2005-06, but it said that the overlap with some NHS 111 services made cost comparisons difficult.
Margaret Hodge, chairwoman of the parliamentary Public Accounts Committee, said that the report by the National Audit Office1 had revealed deficiencies in the current system that needed to be tackled urgently.
The audit office acknowledged that most clinical commissioning groups—which oversee most out of hours services at a local level—were appropriately monitoring the performance of providers and challenging them where necessary. But it said that NHS England—which commissions about 10% of services directly from GP practices that have retained responsibility for providing out of hours care—was doing “very little to manage and oversee these services.” Responding to the report, Hodge said, “NHS England and the Department of Health have not put in place effective oversight arrangements to look at the quality and value for money of [out of hours] GP services—representing a serious governance failure within this important service. “NHS England failed for a full year to give any guidance to its local areas teams on how to seek such assurance. I would have expected NHS England to produce top rate guidance given this delay; instead I am frustrated to learn that the guidance given will not even help to compare the risks and adequacy of different out of hours GP services. “Without this information NHS England will struggle to tell the Department of Health about the quality or value for money of the services taxpayers ultimately pay for. This situation simply cannot go on.” The report also called for NHS England to do more to raise public awareness about the services available, after a survey commissioned by the audit office found that around a quarter
The audit showed that the number of cases handled by out of hours GP services had fallen significantly in recent years, from an estimated 8.6 million in 2007-08 to 5.8 million in 2013-14. The report said that some of this fall was attributable to the introduction of the NHS 111 telephone triage service.
Amyas Morse, head of the National Audit Office, said, “Although some clinical commissioning groups are achieving value for money, this is not the case for the commissioning of all out of hours GP services. NHS England has much to do to help secure improvements throughout the system and to increase its oversight of the out of hours GP services it commissions directly.”
An NHS England spokesperson said, “We are confident that the new out of hours assurance process brought in earlier this year (March 2014) is robust and has addressed many of the issues outlined by the National Audit Office. We will, however, carry on developing processes to ensure that patients continue to receive high quality care and access to a GP outside of surgery hours.” Chaand Nagpaul, chairman of the BMA’s GP committee, said, “With the introduction of NHS 111, it is important that in the future out of hours care is not assessed in isolation but as part of a wider urgent care system, particularly given the interdependence between call handling and the provision of care.” 1 2
National Audit Office. Out of hours GP services in England. 11 July 2014. www.nao.org. uk/report/hours-gp-services-england/. Iacobucci G. 86% of English patients are satisfied with GPs, but fewer are happy with out of hours care. BMJ 2014;349:g4448.
Cite this as: BMJ 2014;349:g4591 © BMJ Publishing Group Ltd 2014
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