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Quality of out-of-hours care ‘varies’

9 October 2014

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The Care Quality Commission (CQC) has inspected 30 NHS GP out-of-hours services and found examples of excellence practice, but also variation in quality. 

Professor Steve Field, chief inspector of general practice, gathered information from out-of-hours inspections into a report. 

Good practice seen in these inspections included:

 – Out-of-hours services self-monitoring the quality of care they provided and shared lessons learned from specific situations.

 – Most the GPs were from the local community, therefore the care people received was from doctors that were aware of the services available and the needs of the local population

 – Some examples of practices that were making an effort to reach out to people who have poor access to primary care and raised awareness of the services on offer

 – Responsiveness to feedback from local patients, for example one practice provided transportation to the practice, after patients complained they did missed appointments due to lack of transport

A difference in quality of care and safety was also observed in certain providers and examples of bad practice included:

 – Not having safe mechanisms for storing and checking stock of medicines

 – A lack of an appropriate recruitment processes

 – No adequate system in place for checking equipment, including emergency medicines

 – Not informing patients how they could make complaints about the service

Steve Field said: “Out-of-hours services are often considered to be higher risk than those provided during the day by GP surgeries and we know that some have seriously failed people in the past. At the start of our inspections, I did not have high hopes about the quality of out-of-hours care. However, I am delighted that these inspections have shown that in most cases the care people receive out of hours is safe, effective, caring, responsive and well-led.

“We saw lots of good practice and it’s important that these services learn from each other to improve their services. There are also some important lessons in here for all GP services to learn from, including those that only provide care during the day. This will help tackle the variation we saw and ensure that everyone receives a high quality service whatever time of day they need to access primary care.”

The inspections were a chance to see the progress made since the 2010 review of out-of-hours, which was led by Professor Steve Field in his previous role of Royal College of General Practitioners chair and Professor David Colin-Thomé, in his former role of National Director for Primary Care. 

Professor David Colin- Thomé said: “We have been impressed by the good quality of most of the GP out-of-hours providers visited. GP OOH services are frequently subject to unwarranted criticism. This report taken together with the recent NAO report provide evidence to repudiate much of that criticism. As in all healthcare services of course, high quality is not uniform, and we have identified good and sometimes not so good performance.”

The 30 service providers are run by 24 organisations and provide out-of-hours care for approximately 36% of the population in England.

Deputy Medical Director at NHS England, Dr Mike Bewick said: “Patients need a consistent, high quality service in and out of hours and the feedback from this report is encouraging. Where variations and inconsistencies have been identified, I am pleased that action has been taken to put improvements in place.

“It is important that clinical commissioning groups and GP services look at the many good examples of excellent practice across the country alongside ongoing feedback from their patients, to drive improvements.”