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Approximately 9 million patients receive urgent primary out-of-hours care in England every year. The term out-of-hours care refers to care delivered between 6:30 pm and 8:00 am on weekdays and at all times during weekends and public holidays.
Prior to April 2004 GPs were responsible for the provision of this care, but most provided the service either by pooling their responsibility through a GP co-operative or delegating it to a commercial deputising service. Responsibility for this service had become unpopular with GPs and there were rising levels of complaints from patients. With effect from April 2004 the Department of Health gave GPs the chance to opt out of personal responsibility for the service under a new General Medical Services contract agreed with the medical profession. Where a GP opted out, he or she gave up an average of £6,000 per year and the local Primary Care Trust took over responsibility for the out-of hours service for the GP's patients.
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department on three main issues: the Department's preparation for the new out-of-hours service; the performance of the new service; and its costs.[1]
We found that preparations for the new service were shambolic, both at the national and local level. The Department took part in the negotiation of the new General Medical Services contract only as an observer, and only the doctors did well out of the deal on out-of-hours costs. The Department also failed to explain whether the service should be for urgent care or all unscheduled health needs.
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. For example only 2% could report that they complied with one standard. Some providers were simply unable to report at all. The cost of the new out-of-hours service has also been some £70 million a year higher than foreseen.
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