Problems with the A&E GP service raise new questions over the viability of controversial NHS England plans to place GPs at the front door of every A&E in England by this Christmas to help the health service avoid another serious winter crisis.
Out-of-hours provider Integrated Care 24 (IC24) said it does not compromise on patient safety after a quality report published by West Kent CCG revealed concerns over missing GP training data and expired indemnity. The report found that up to 19% of shifts at its A&E services were not covered by a GP.
IC24, a not-for-profit provider, runs over 50 GP out-of-hours and primary care centres across south-east England. It is commissioned by West Kent CCG to provide GP out-of-hours services at two A&E departments and a home treatment service.
In a quality report published by West Kent CCG last month, commissioners revealed a series of concerns over IC24’s services.
It said there ‘remain concerns in relation to mandatory training for IC24’s 72 sessional GPs, as compliance data had missing information for 40% of doctors’.
The report revealed that data showed 3% of IC24’s GPs had expired indemnity insurance and one GP’s GMC registration had expired.
A spokesman for IC24 said it had rigorous process to ensure compliance with training, indemnity and GMC requirements. The GMC registration incident, it said, was caused not by lack of registration but by an administrative error.
But concerns were also raised by commissioners over fill rates for IC24’s A&E GP services at Maidstone and Tunbridge Wells. It found that Maidstone had seen 15% unfilled by a GP, while Tunbridge Wells 18% unfilled.
The report said: ‘Concerns remain in relation to the number of GP shifts unfilled for the two GP and A&E services, for which no agency staff were used to cover for this period.’
IC24 said it was exceeding its contractual requirement to fill 80% of shifts, with the remainder covered by the Maidstone and Tunbridge Wells Trust.
GP leaders have raised concerns over government and NHS England plans to set up GP services at every emergency department in England by Christmas.
The government announced in the budget £100m capital funding to help set up primary care triage and streaming systems at 100 A&Es. NHS England has said every one of England’s 139 major type-1 A&Es will have triage systems in place in time for the winter demand peak. The BMA has warned the plans could deepen the NHS crisis by attracting patients to hospital, while the RCGP said GPs should be in their communities not in emergency departments.
Commissioners will have to staff and fund the triage services and could be expected to use the existing out-of-hours GP workforce.
GPonline asked IC24 to explain what was causing the staffing and compliance problems and how it was resolving them. Chief medical officer Andrew Catto said: ‘IC24 does not compromise on patient safety. We have rigorous processes in place to ensure that GPs comply with their responsibilities to provide us with paperwork relating to matters such as mandatory training, indemnity insurance and GMC registration and to hold them to account if information is not provided.
'In respect of a GP who was reported to not have GMC registration, it has been established that the GP does have valid registration, and that doubt arose due to a technical error, which has been resolved. In respect of rota fill, we are in fact exceeding our contractual obligations but we continue to work closely with CCGs to find innovative ways to address the GP recruitment crisis.’
West Kent CCG declined to comment on how it was resolving the issues raised in its quality report.