Memorandum by the Patients Association
(COM 110)
COMMISSIONING
Executive Summary
1.1 The Patients Association believes the
Committee would gain useful insight into the ability of Primary
Care Trusts to successfully commission services by reviewing the
commissioning of out of hours care services. It would highlight
concerns about the ability of Primary Care Trusts to commission
safe and effective services for their local populations.
1.2 The Care Quality Commission publication
Care Quality Commission's Update on enquiry into Take Care
Now and out-of-hours services (2009) indicates this is a significant
problem nationally.
1.3 Results from the national GP patient
survey highlight the very wide variation in patient satisfaction
with the service and FOI based research conducted by the Patients
Association highlights further variation in cost and monitoring.
This is also supported by research conducted by the Primary Care
Foundation.
1.4 Commissioning of out of hours care is
a useful indicator because PCTs were largely expected to commission
the service from the same starting point, without being able to
rely on simply referring to historical providers, as is done very
frequently in the commissioning of secondary care services.
Out of hours care
1.5 There have been national concerns raised
about ensuring PCTs commission safe out of hours care for a number
of years (The Panel Report for the Serious Untoward Incident investigation
into the death of Penny Campbell 2007) and recently highlighted
by the death of David Gray in 2008.
1.6 We would refer the Committee to the
Care Quality Commission's Update on enquiry into Take Care
Now and out-of-hours services (2009) for consideration of
further concerns around safe commissioning of OHC in general.
1.7 Much of the interest around the cases
of poor out of hours care has surrounded the issue of eligibility
of particular doctors to work in the service.
1.8 Whilst this is a valid and important
concern we also feel that basic safety assurances should have
been sought by PCTs as part of their duty to commission safe,
high quality OHC on behalf of the local population.
1.9 The value of this issue is that it is
a good example of a requirement of all PCTs to individually commission
a service that needs to meet a variety of health needs in a variety
of circumstances, without the ability to revert to historical
providers (as is usually the case with secondary care) as a starting
point.
1.10 Please see Appendix 1 for a summary
of the result of research conducted by the Patients Association
which highlights the wide variation in patient satisfaction found
by the GP patient survey (Ev 169) and in spending (Ev 170) according
to answers provided by PCTs to an FOI request.
1.11 As Appendix 1 highlights, the data
provided by the FOIs has some caveats but its conclusions
(in highlighting wide variations in spend) are also supported
by research conducted by the Primary Care Foundation (ibid).
1.12 Of particular concern are answers given
by a number of PCTs to questions relating to complaints and serious
untoward incidents (Ev 172).
1.13 This variation in the quality of services
would suggest a variation in the ability of PCTs to commission
effectively. This is concerning and suggests much more research
is required into the ability of PCTs to commission effectively
if we are to confident that they will be able to fulfil their
role on behalf of local populations.
1.14 The ability of some or many PCTs to
commission safely brings little comfort to patients that have
a local PCT that is ineffective.
March 2010
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