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Memorandum on the provision of the out-of-hours GP service in Cornwall

Whistleblowers played a significant role in highlighting concerns about the out-of-hours GP service in Cornwall, prompting Serco and the primary care trust to take action, a report by the National Audit Office has found. Following a request from the Chair of the Public Accounts Committee, the NAO looked into what had happened.

Among the concerns raised was that Serco had been unable to fill shifts with appropriately qualified staff, with the result that the out-of-hours service was unsafe. A clinical review of the service in June 2012 found no evidence that the service was, or had been, systematically clinically unsafe.

During 2012 Serco regularly had insufficient staff to fill all clinical shifts. It also frequently redeployed some GPs, taking them out of the cars available for home visits and using them to cover clinic shifts instead. In July 2012, the Care Quality Commission reported that the out-of-hours service did not have enough qualified, skilled and experienced staff to meet people’s needs. When it inspected the service again in December 2012 the Commission found that, although the number of clinical staff had increased, Serco needed to take further action because there were not enough health advisers who handle incoming calls.

Serco has not consistently met the national quality requirements for out-of-hours services set by the Department of Health. Performance against the requirements declined significantly following the introduction in May 2012 of NHS Pathways, as required by the primary care trust, a new system for assessing patients’ needs when they call the service. Serco has since taken steps in response to the problems, including using more clinical staff to support the health advisers handling calls, and performance is now recovering.

Whistleblowers raised concerns that Serco staff were altering data about the performance of the out-of-hours service. A forensic audit by Serco, covering every interaction which passed through the switchboard between January and June 2012, found that two members of staff made 252 unauthorised changes to performance data. This represented 0.2 per cent of all interactions with patients during the six-month period.

As a result of the data changes, the performance Serco reported to the primary care trust was overstated in seven instances. Serco and the primary care trust have since taken steps to strengthen internal controls aimed at preventing or detecting data changes.

Whistleblowers’ concerns had not been identified by routine management controls or by the primary care trust itself. Serco had a whistleblowing policy but evidence suggests that whistleblowers were still fearful of raising concerns. Serco and the primary care trust have since reminded all staff of the importance of raising concerns and the protection available to whistleblowers.


Notes for Editors

  1. Out of hours services provide urgent primary care when GP surgeries are closed – from 6.30pm to 8.00am on weekdays and all day at weekends and on bank holidays. Since 2004, the General Medical Services contract has allowed GPs to choose whether to provide out of hours services or to transfer responsibility to their primary care trust. Since 2006, the out of hours service in Cornwall have been provided by Serco, under a contract with Cornwall and Isles of Scilly Primary Care Trust. Kernow Clinical Commissioning Group will take over responsibility for the contract from 1 April 2013.
  2. Press notices and reports are available from the date of publication on the NAO website, which is at Hard copies can be obtained from The Stationery Office on 0845 702 3474.
  3. The National Audit Office scrutinizes public spending for Parliament and is independent of government. The Comptroller and Auditor General (C&AG), Amyas Morse, is an Officer of the House of Commons and leads the NAO, which employs some 860 staff. The C&AG certifies the accounts of all government departments and many other public sector bodies. He has statutory authority to examine and report to Parliament on whether departments and the bodies they fund have used their resources efficiently, effectively, and with economy. Our studies evaluate the value for money of public spending, nationally and locally. Our recommendations and reports on good practice help government improve public services, and our work led to audited savings of more than £1 billion in 2011.

PN: 15/13