PERFORMANCE AGAINST THE QUALITY REQUIREMENTS
9. Before April 2004, Primary Care Trusts did not
deliver or manage out-of-hours services. When taking on this responsibility
in 2004, two-thirds found that the management information they
could obtain on the service was of poor quality or simply not
available. The Department's management information arrangements
therefore started from a very poor information base, although
the Department has since been expanding its information base to
help inform how the service will be taken forward in the future.[13]
10. In 2000, the Department commissioned a review
of out-of-hours care, known as the 'Carson Review'. The review
identified ways of assuring quality in out-of-hours services and
made 22 recommendations to improve those services, all of which
were accepted by the Department. Recommendation 21 stated that
by April 2001 out-of-hours providers should start to report on
performance against quality standards, but only some did, and
those that did report did not do so in a consistent way.[14]
11. New standards were introduced from January 2005,
when out-of-hours providers were required to meet national Quality
Requirements established by the Department. The Quality Requirements
were widely agreed by providers and commissioners to be an improvement
on their predecessors. There was, however, confusion over whether
providers and commissioners should aim for 100% compliance with
the Quality Requirements or whether a lower level of compliance,
such as 95%, could suffice, which the Department intended to clarify.[15]
12. Actual performance against the Quality Requirements
was poor, and reporting against the targets incomplete. For example,
a third of Primary Care Trusts were unable to say what their performance
had been against the target to start a definitive clinical assessment
within 20 minutes following an urgent phone call and fewer than
10% of Primary Care Trusts were able to say that they had fully
met the target. Some Primary Care Trusts lacked equipment to monitor
their performance, for example, in handling telephone calls, although
the IT equipment needed to do so exists and could have been obtained.[16]
13. Figure 1 sets out the performance of all
Primary Care Trusts against those Quality Requirements relating
to access to advice and treatment. The Department accepted that
there was a need to improve in three main areas: in making a clinical
assessment; in call handling; and in face-to-face consultation.
The Department expected Primary Care Trusts to address areas where
their performance fell short of the targets, and local Strategic
Health Authorities were responsible for investigating Primary
Care Trusts that did not do so. The Department also intended to
review the Quality Requirements.[17]
Figure 1: Performance against the Quality Requirements
