Select Committee on Public Administration Minutes of Evidence

Examination of Witnesses (Questions 96 - 99)




  96. Would you like to say anything by way of introduction?
  (Mr Thompson) Not particularly but we are very keen to look at the complaints procedure as a whole. I know that most of your discussions up to this point have been concentrated around primary care and the out-of-hours service. I suspect that it may be more appropriate if you pursue those and perhaps widen it out to the broader complaints procedure later on, if that is in order.

  97. We will ask questions all over the place. First, and you have heard the previous session, does not the Department of Health have a responsibility in this matter, too? Here was an out-of-hours service serving a quarter of all GPs in the country and yet it turns out it could have been operating in this way with these consequences with no effective monitoring of what it was doing. What is the Department's responsibility in this?
  (Mr Thompson) It might be appropriate at this stage to ask David Carson to describe some of the work that has been going on in the whole area of out-of-hours service.
  (Mr Carson) I was commissioned by the Department in March last year to carry out a review of GP out-of-hours services, which I did with a small team. Included in the remit of the review was to look at the potential to set quality standards for all GP out-of-hours services, including those provided by commercial deputising services, GP co-operatives, GP rotas and GPs who undertake to do their own on-call for their own lists. We reported to the Department in September of last year in the report on basic standards for patients in partnerships with merged care. The Department of Health has adopted those recommendations that we made in relation not only to the quality standards but to the mode of service, the commissioning and planning of the service and the accountability of providers of out-of-hours services. The Department is looking forward to implementing the recommendations and I am currently working on implementing those recommendations.

  98. Tell us in a nutshell how these recommendations would remove the kinds of problems that we identified in these cases.
  (Mr Carson) What we have laid out is the system, a model of service, which is supported by a set of quality standards. One of the principles that sits behind those quality standards is the early clinical assessment of the patient's call as soon as he enters the system. If the patient lifts the telephone, we are recommending that the patient only makes one telephone call, that he does not have to re-dial, and we have set out standards that the patient's call will be answered in a certain time and will be assessed by a clinician. We have recommended that 90 per cent of calls are assessed within 20 minutes and 100 per cent in 30 minutes.

  99. So it is not the initial call going to the clinician but, as we have heard from previous witnesses, it will be referred to a clinician?
  (Mr Carson) Yes, it will be referred to a clinician within those times. We have also set standards which describe the time in which the organisation should be able to identify those conditions which may be life-threatening and require a much more urgent response than the 20 or 30 minutes' assessment time. We are really building on systems that already exist within NHS Direct or within ambulance services so that lay operators can use a decision algorithm to prioritise and identify those calls that require an immediate ambulance response.

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