Doctors’ leaders have produced a 10 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 10 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) Care to be
configured around the needs of patients with better signposting for
access
2) All GP
practices to have a system for responding to and dealing with
urgent care during surgery hours.
Although 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) 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) Quality
standards including clinical outcomes to be monitored and
enforce.
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) Stronger
multidisciplinary urgent care teams whose members have been trained
to nationally agreed standards, and training opportunities in
urgent care for GP Registrars
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) Emergency
care practitioners to be trained to a defined national standard
including an assessment of competence.
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) 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. “
Ends
Media enquiries should be directed to
Gillian Watson, RCGP PR Manager, or Lorna Fletcher, Press Officer,
on 020 7344 3135 / 3136 or press@rcgp.org.uk
For out of hours media enquiries
please contact the duty press officer on 07885 958 632
Notes to Editors:
View the full urgent care
paper
The RCGP has adopted the Department of
Health’s definition of urgent care:
‘Urgent care is the range of responses that
health and care services provide to people who require – or who
perceive the need for – urgent advice, care, treatment or
diagnosis. People using services and carers should expect 24/7
consistent and rigorous assessment of the urgency of their care
need and an appropriate and prompt response to that need.’
The Out of hours period is 6.30pm to 8.00am
Monday to Friday and all weekend.
Urgent care encompasses:
- emergency care, such as that provided by an
A&E department;
- unscheduled care i.e. services that are
available for the public to access without prior arrangements, such
as walk-in centres; and out of hours care
The RCGP has consistently raised the issue of
urgent care with the Department of Health. Urgent care was
mentioned in the RCGP General Election Manifesto and its submission
to the consultation on the White Paper submission. The previous Out
of Hours accreditation scheme was devised by the RCGP and was
implemented widely by PCTs until accreditation requirements were
changed by the Department of Health in 2004.
The Royal College of General Practitioners is
the largest membership organisation in the United Kingdom solely
for GPs. It aims to encourage and maintain the highest standards of
general medical practice and to act as the “voice” of GPs on issues
concerned with education; training; research; and clinical
standards. Founded in 1952, the RCGP has over 25,000 members who
are committed to improving patient care, developing their own
skills and promoting general practice as a discipline.