GPs' out-of-hours cover criticised

The provision of out-of-hours primary medical care has been criticised in a report by the National Audit Office.

The report found that there were shortcomings in the process of setting up the service in 2004, but said that there was no evidence that patient safety had been compromised.

The Primary Care Trusts which took over responsibility for the service from GPs, lacked knowledge and experience in this area, the NAO said.

The report said that the service was now beginning to reach a satisfactory standard, but said that none of the providers was meeting all the requirements and few were reaching the requirements for speed of response.

The report found that fewer than 10% of PCTs who responded to the NAO's survey were 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.

The report also said that 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 costs for the first full financial year of arrangements was £392 million, 22% more than the £332 million allocated by the Department.

The report suggested that there may be scope to reduce costs, with NAO analysis showing 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.

However, according to a survey conducted for the report, patient experience of the out-of-hours service is generally good, with eight out of ten patients saying that they were satisfied with the service, while six out of ten patients are seen within two hours and four out of ten are seen in less than one hour.

Sir John Bourn, Head of the NAO, said: "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."

Commenting on the report, Dr Hamish Meldrum, chairman of the BMA's GPs Committee, said: "It is worrying that, in places, quality targets such as response times are not being met. Clearly it is unacceptable for patients to face delays and better integration of services and planning is needed, particularly in anticipating peak demand times."

Liberal Democrat Shadow Health Secretary Steve Webb said: "Once again the government has introduced a health service reform, the true cost of which has been seriously under-estimated.

"Local Primary Care Trusts have had to pick up the tab for the government's failure to provide adequate funding for the new out-of-hours arrangements. This in conjunction with the under-funding of the new GP contracts has resulted in cuts in frontline services.

"It is incredible that the government should repeatedly blame local NHS managers for funding problems when time and again the government has failed to assess the full cost of changes."

(KMcA)