Signposting the way to better out of hours services for patients

Citation

(2008), "Signposting the way to better out of hours services for patients", International Journal of Health Care Quality Assurance, Vol. 21 No. 1. https://doi.org/10.1108/ijhcqa.2008.06221aab.007

Signposting the way to better out of hours services for patients

Keywords: Healthcare information, Service delivery, Healthcare assessment

Doctors’ leaders have produced a ten point plan to help patients navigate their way through the “maze” of out-of-hours (OOH) services.

The Royal College of General Practitioners says that services are confusing, fragmented, of highly variable quality and that urgent action is needed to restore confidence in out-of-hours services. It is publishing the plan in direct response to concerns from members and patients and in advance of a Department of Health Review of “urgent” care services.

The RCGP plan recognises the pivotal role of GPs and includes across-the-board recommendations for the Department of Health, Primary Care Trusts (PCTs), GP practices and health organisations to improve urgent care services for patients.

Patients – and doctors – say out of hours services have been a cause of confusion since 2004 when the new GMS contract was introduced and PCTs took over responsibility for commissioning out of hours care in England.

While the RCGP recognises that good quality urgent care exists in some areas, it highlights a clear need for better signposting as patients are often unable to determine the most appropriate service to access. It has also identified concerns about variation in quality of out of hours services.

To address this, and to kickstart action in improving urgent care services, the RCGP will shortly launch a national Out of Hours Clinical Audit Toolkit, which will enable PCTs to monitor clinical outcomes.

RCGP Chairman Professor Mayur Lakhani, a practising GP in Leicester, said: “We are concerned that GPs are being blamed unfairly for the state of out-of-hours services when the responsibility for commissioning and providing OOH services resides with primary care trusts and not GPs.”

“Nonetheless we acknowledge that this has been a difficult issue for the profession and that many GPs agonised over their decision to opt out of 24 hour contractual responsibility. GPs are still involved in OOH rotas and a large proportion of OOH is still provided by GP co-operatives. PCTs must make efforts to engage and involve GPs in out of hours care: some PCTs have already managed to do this effectively.”

The RCGP ten point action plan recommends that services are designed around the clinical needs of patients who should expect to receive a consistent and rigorous assessment of their needs and an appropriate and prompt response to that need – regardless of who is administering their care.

The action plan calls for:

1. 1.

   Care to be configured around the needs of patients with better signposting for access.

2. 2.

   All GP practices to have a system for responding to and dealing with urgent care during surgery hours. Athough no longer contractually responsible for out of hours work, they should champion optimal levels of urgent care for their patients and practices must have systems in place for alerting urgent care providers to patients with complex healthcare needs.

3. 3.

   PCTs to develop Urgent Care Networks comprising GP practices, walk-in centres and minor injury units to foster integration and co-ordination of care between providers.

4. 4.

   Quality standards including clinical outcomes to be monitored and enforce.

5. 5.

   Engagement with local GPs and recognition of their key role in leadership, planning and support for urgent care and out of hours services.

6. 6.

   Stronger multidisciplinary urgent care teams whose members have been trained to nationally agreed standards, and training opportunities in urgent care for GP Registrars.

7. 7.

   The Department of Health to make urgent care a priority and set a clear national strategy, emphasising the necessity for high clinical standards.

8. 8.

   Emergency care practitioners to be trained to a defined national standard including an assessment of competence.

9. 9.

   The Healthcare Commission to ensure that the quality and safety of urgent care is monitored and to make recommendations for improvement based on their findings.

10. 10.

    Primary care educators to ensure that the quality of urgent care training receives a high priority and establish a systematic approach to the training of GP Registrars. Urgent care competencies should also be incorporated within GP appraisal and CPD.

Professor Lakhani said: “A step change in policy is needed. Being ill in the middle of night is frightening experience and patients need to be sure the NHS will be there for them.

“The majority of care is still provided by GPs. As the proven experts in providing urgent care, it is important that GPs have a strong influence on urgent care. Any attempt to downgrade the role of GPs will lead to further diminution of quality and put pressure on other parts of the NHS.

“We are aware of excellent service provision in some areas but also have significant concerns about fragmentation of care and a lack of signposting to services. We urge that PCTs be held to account for the quality of their out of hours services. Some PCTs have managed to get it right so why not others?

“The Out of Hours Toolkit will help to ensure that the spotlight remains on high standards of patient care – measurement of clinical quality is essential. It is imperative that primary care providers work together to address these problems – access to good quality urgent care should be the preserve of all, not the lucky few.”

Ailsa Donnelly, Chair of the RCGP Patient Partnership Group, said: “Patients are very confused and bewildered about which services may be available to them outside GP surgery appointments. Clear signposting to appropriate care is essential, and this plan will go a long way towards demystifying the maze that currently exists.”

For further information: www.medicalnewstoday.com