Many primary care trusts are unable to measure their performance on out-of-hours care, partly because providers do not have the necessary telephone systems, the House of Commons Public Accounts Committee (PAC) has concluded.

The PAC report on out-of-hours (OOH) care  found that PCTs were failing to meet quality requirements, due to a combination of poor performance and inadequate performance measurement.

It found that out-of-hours care has cost £70m a year more than expected since responsibility transferred from GPs to PCTs in 2004 and concluded that only doctors did well out of the deal.

New standards introduced in 2005 require out-of-hours providers to meet national quality requirements but the committee said performance against the requirements had been poor and reporting against the targets incomplete. Only 2% or providers could report that they complied with the requirement to answer calls within 60 seconds.

A third of PCTs were unable to say what their performance had been against the target to start a definitive clinical assessment within 20 minutes following an urgent phone call and fewer than 10% of PCTs were able to say that they had fully met the target.

The report adds: “Some primary care trusts lacked equipment to monitor their performance, for example, in handling telephone calls, although the IT equipment needed to do so exists and could have been obtained.”

Lynn Woods, managing director of Adastra, the out-of-hours IT supplier to 83 of the 88 operational hubs in the UK, said many providers were using switchboard systems first provided by cash-strapped GP co-operatives and had been unable to afford to upgrade to newer systems which could capture the information required by the quality requirements.

Woods criticised the PAC report which he said seemed to be largely based on last year’s National Audit Office report, a study which he described as “ill-evidenced” itself.

Woods told EHI Primary Care: “The PAC is regurgitating what the National Audit Office said 10 months ago and we had serious reservations at the time about the quality of information that it based its conclusions on.”

The PAC report revives the NAO finding from last year that £134m could be saved if every PCT provided its service at the same cost as the most cost-effective.

However Woods said the costings were not correct and that had added to the pressure on providers to make cost-savings.

He said monitoring the national quality requirements was also proving problematic for providers because the standards were hard to match against the complexity of providing out-of-hours care and the different ways in which providers offered services.

He added: “There are problems mapping the doctrinaire nature of the requirements on to the practical shape of services although the Department of Health is now taking a common sense approach and there are an awful lot of positive things going on.”

The PAC report recommends that the Department of Health sets a timetable for PCTs to benchmark their services against their peers, requires strategic health authorities to report on their performance, and holds to account PCTs whose costs remain seriously out of line.

The committee said preparations for the new service were “shambolic” and Edward Leigh, chairman of the PSC added: “The Department of Health thoroughly mishandled the introduction of the new system of out-of-hours care.”

The committee said that the Department of Health’s management information started from “a very poor base” in 2004 when out of hours responsibility transferred from GPs to trusts with two-thirds of PCTs reporting that management information did not exist or was or poor quality.

The report adds: “The new service is undoubtedly now starting to improve. But actual performance against the key access targets is still not good enough. The percentage of providers meeting the requirements for call answering, definitive clinical assessment and consultation times is extremely low.”


Public Accounts Committee report: The provision of our-of-hours care in England

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