Press Release - The Provision of Out-of-Hours care in
England
5 May 2006
There were shortcomings in the process of setting up new
arrangements to provide out-of-hours primary medical care in 2004,
although there is no evidence that patient safety was compromised,
the National Audit Office reported today. The Primary Care Trusts
(PCTs) who took over responsibility for organising out-of-hours
services from GPs lacked knowledge and experience in this area.
However, most patients say that they are receiving a good service,
with six out of ten rating it as excellent or good.
The report finds that, after some initial problems, the service
is beginning to reach a satisfactory standard, but that no
providers are meeting all the required levels of performance and
few are achieving the required levels for speed of response. The
report also finds that the actual costs of providing out-of-hours
care under the new system are considerably more than the specific
Department of Health allocation made to support these services and
that there is scope to reduce costs without compromising
quality.
Before 2004, GPs were responsible for organising out-of-hours
services, although seven out of ten GPs did not directly provide
their out-of-hours service. In response to concerns that this
system was not sustainable, the Department decided to offer GPs the
chance to pass on their responsibility to Primary Care Trusts. Most
GPs did so during a period from April to December 2004. By April
2005, 75 per cent of out-of-hours provision was being carried out
by the Trusts themselves or through co-operatives, with the
remaining 25 per cent provided by commercial providers, ambulance
trusts and others, and with NHS Direct supplying initial call
handling for many providers.
PCTs had not previously managed or delivered out-of-hours
services and so lacked experience and reliable management data.
When they took over, there was little information about fundamental
factors such as demand or cost.
The service is now beginning to reach a satisfactory standard
but no providers are meeting all the requirements and few are
reaching the requirements for speed of response. Fewer than 10 per
cent of PCTs who responded to the NAO’s survey are meeting the
speed of response targets - that a clinical assessment should be
started within 20 minutes of a call for urgent cases and within 60
minutes of a call for non-urgent cases.
Some PCTs are still confused over whether the out-of-hours
services should be restricted to urgent cases or should respond to
any request for medical care outside normal working hours –
although there is no evidence patient safety is being
compromised.
According to a survey conducted for the report, patient
experience is generally good. Eight out of ten patients are
satisfied with the service, while six out of ten rate the service
as excellent or good. During the out-of-hours period, the majority
of patients (six out of ten) are seen within two hours and many
(four out of ten) are seen in less than one hour.
The actual costs of providing out-of-hours care under the new
system are considerably more than specific Department of Health
allocations to support out of hours services. The total cost for
the first full financial year of arrangements was £392 million, 22
per cent more than the £322 million allocated by the
Department.
There may be scope to reduce costs. The NAO’s analysis shows
that if all Primary Care Trusts were as good as the best
performers, a saving of £134 million a year could be achieved
without compromising quality.
Sir John Bourn said today:
“The Department of Health is now on track towards
providing high-quality out-of-hours services. I am glad to see
signs that Primary Care Trusts are getting better at managing their
providers.
“However, it is disappointing that there were so many
problems in starting the new arrangements and I am concerned that
so few providers are meeting their targets for the time it takes
respond to patients. And the continuing confusion over whether
out-of-hours is supposed to be an urgent or unscheduled care
service should be dispelled without delay.”
Notes for Editors
- Press notices and reports are available from the date of
publication on the NAO website, which is at www.nao.org.uk. Hard
copies can be obtained from The Stationery Office on 0845 702
3474.
- The Comptroller and Auditor General, Sir John Bourn, is the
head of the National Audit Office which employs some 800 staff. He
and the NAO are totally independent of Government. He certifies the
accounts of all Government departments and a wide range of other
public sector bodies; and he has statutory authority to report to
Parliament on the economy, efficiency and effectiveness with which
departments and other bodies have used their resources.
Press Notice 35/06
All enquiries to NAO Press Office:
Mark Strathdene, Tel: 020 7798 7183: Mobile: 07748 181 693 or
Mark Anderson, Tel: 020 7798 7558; Mobile: 07748 181 692