Select Committee on Public Administration Minutes of Evidence

Examination of Witnesses (Questions 80 - 95)




  80. We can explore that with the Department.
  (Mr Buckley) The regulations make it clear that the GP is responsible for whatever care is provided to his or her patients, unless, which one may find out later, it is provided by an independent GP principal. Therefore, under the system, complaints have to go to the GP on whose list the patient may be. In one particular case the GP dealt with it by having the patient removed from his list. It is unfair to blame Healthcall for that.

Mr Lepper

  81. I was not going to go on to blame Healthcall for that at all! I was surprised that perhaps Healthcall were not aware that there had been that consequence in one case. I suppose, assuming that you were aware of it, my question was going to be whether you had made any representations in that case to the GP on behalf of the complainant. It is not that you would have the responsibility to do that, but nevertheless we now have the situation where the patient does not have a doctor and must find another GP.
  (Dr Dun) We genuinely were not aware of that. I have been in conversation with some of the Ombudsman's officers on the whole area of how out-of-hours services fit in with a practice-based complaints procedure. That is the vehicle by which primary care manages complaints and has been since 1996. It is at times confusing. I do not believe that is just for deputising services; I think that is an issue for NHS Direct and other out-of-hours providers. We have done some work on this and we have corresponded on it. We really would like to play our part in how we fit in with a practice-based complaints procedure.

Mr Wright

  82. In terms of the operators and the guidance that you give to the operators, how often do you review that? Would that be when an incident occurs or would you review it on a regular basis?
  (Dr Dun) We would review it on a regular basis. We have established a clinical standards group to review all clinical guidelines and protocols. That is not to say that we do not have a significant event policy, which we have introduced within the last three months, so that if, as the result of an individual event, something came to light outwith the normal work of the review that meant the procedures needed to be reviewed, it could be picked up. Yes, we do have the opportunity to review things if an individual case occurs that warrants it.

  83. Bearing in mind the number of areas that you cover with 31 bases and 60 satellites, how do you convey that across the network? Would it be through this bulletin that you put out?
  (Dr Dun) The bulletin is aimed for the duty doctors and as a clinical information tool. It might say, "Here is something where we did not do so well and there are opportunities for learning". If we were going to alter policies and operating procedures, we would do that through the network of operational managers and local medical directors in each of the branches.

  84. In terms of the branches themselves, how do you determine how many doctors you require for an area? Is that done per number of the population?
  (Dr Dun) There is an number of variabilities; for example, how the service is delivered. We still have a range where, in some of our branches, 30 per cent of calls are responded to by a home visit, whereas in others we are at 10 per cent. Obviously the configuration of how many doctors are needed varies. Rather than X per 100,000—and this makes sense going forwards—we measure our response times against the various priority categories. The ability to be able to flex the workforce and to hit the target which the out-of-hours review team has set down as a minimum is the way that we do it and 30 years of experience helps in forming rotas. That is how we measure if the numbers are working.
  (Mr Burns) May I add that some branches with very similar GP customer bases actually have very different call volumes. That is partly socio-economic and partly the age and profile of the population. We also measure call volumes to make sure that we are properly covered. A branch with 600 GP customers can have a varying call volume coming in and we need to make sure that we cover base on the demand that comes through.
  (Dr Dun) It is interesting that our South Wales branches have two and a half times the call rate of Nottingham, for example. It is not easy to understand why that should be.

  85. In terms of when a doctor on-call in the evening gets a call-out, would he or she drive himself or herself to the patient or do you have a system with a driver to take that doctor around the areas?
  (Dr Dun) In every case there is a driver. In a number of branches—and we need to evaluate this more fully—there is the concept of patient transport. We use Ford Galaxy type vehicles to bring patients who are medically able to travel but who do not have transport to get to us. Obviously we are not asking people to come when it is clinically inappropriate. We are looking at various ways of being able to use our centre-based care rather than home visits if possible.

  86. If there was a home visit, the doctor could not get lost in an area because he would have a driver with local knowledge?
  (Dr Dun) Absolutely and the IT developments in navigation systems will make that far better than currently.
  (Mr Burns) We are about to pilot proven technologies that the ambulance service and RAC use, which is satellite navigation, which makes it that much easier because the system actually tells them where to go. That will be on offer in the next couple of months with a view to running it out across our fleet.


  87. An issue that is identified in these cases is of doctors not being supplied by you with mobile phones and sometimes being out of radio contact when they are driving to new areas, but all that has gone; you now supply them with mobile phones and they are in contact all the time?
  (Dr Dun) Yes, and it was particularly in the Manchester branch that we had problems. We addressed those very speedily. In all the other branches we have different back-up arrangements, whether it be by bleeper or by mobile phone, to support the radio system, which is still fundamental to the business.

  88. Someone less generous than me might say that you are basically a commercial organisation. You make your money by having a lot of money going in and less money going out. Is there not a permanent incentive there for you to have the least number of your doctors available that you possibly can, otherwise you are not going to maximise your income, are you?
  (Mr Burns) I do not think that is the case. The fundamental issue is that all our customers have a choice. If we do not provide an excellent service that is good value for money to them—and, as we have discussed, most of them are on annual contracts—they can quite easily switch to another provider. As far as I am concerned as the Group Managing Director, the highest priority in this group is clinical quality. If we do not provide a high quality service, I do not believe we will have a service because people have a choice and they will quite rightly go elsewhere. The overriding priority for my group is the delivery of a high quality local service.

  89. You say that 70 per cent of the people who work for you are GP principals. Are they currently in-post as GP principals?
  (Dr Dun) Absolutely, and I have the figures here. Currently just over 76 per cent of our clinical workforce are current GP principals; just over 4 per cent are nurses providing nurse triage with decision-based software; and 19 per cent are qualified GPs that are not currently principals.

  90. I wonder why GPs who want to offload night calls then want to sign up to do them through you?
  (Dr Dun) Often what happens is that in a partnership of five or six doctors, there may well be two or three who may well be passionately against doing any out-of-hours calls and would like us to undertake all of that; within that five or six, there are two or three who would like to earn money to offset the bills that we send them every month. There is a variety of factors, and obviously pay is one, for those GP principals who want to work for us.

Mr Trend

  91. When you use rented transport to take people to one of your centres, who pays for that?
  (Dr Dun) We do.
  (Mr Burns) Those are our vehicles.

  92. And you charge the doctors?
  (Mr Burns) That is part of it. We are evaluating whether this is of use at the moment. We have it running in four of the branches where there is probably a greater socio-economic reason why we should try to provide transport. One concern, and we are open about this, is whether it becomes a dependence and, once people actually hear that there is transport available, everyone then demands transport, rather than actually coming in to the centre. The transport is the vehicle fleet and that is provided by us as part of the service that we deliver to customers.

  93. And that is included in the charge you make to them?
  (Mr Burns) Correct.

  94. When you send an ambulance, that would be paid for by the NHS?
  (Mr Burns) Yes.


  95. Thank you for coming along. By way of conclusion, may I say that I accept what you say about the new management team and that we are going back two or three years with these cases but we should not lose sight of the fact that these are the most dreadful cases. There was an absolutely appalling failure of service by your organisation in relation these people. As it happens, we discovered that there were systemic failures across your organisation. We are very used in this Committee to having new management teams coming in and tell is it was the old management team that did all these things. We are not entirely persuaded by that all the time. Thank you very much for coming and talking to us in the way that you have. We hope that what you are saying is the case but we shall look very carefully at what Healthcall does in the cases that come through the Ombudsman's hands. You will understand when I say: we hope very much not to be able to see you again on an occasion like this.
  (Mr Burns) I hope, Chairman, that we do not have to come again to sit in front of you, though as we said right at the start, these cases are indefensible. The cases were appalling. They should not have happened. We hope we have put in train now systems to ensure that does not happen in the future. I hope we do not have to have the privilege of coming in front of you in the future.

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