Concern over NHS 111 as CQC praises GP out-of-hours care

No serious concerns were identified among the first GP out-of-hours providers assessed under the CQC's revamped performance regime, a report by the watchdog reveals.

Professor Steve Field: CQC out-of-hours report (Photo: JH Lancy)
Professor Steve Field: CQC out-of-hours report (Photo: JH Lancy)

However, the report found just half of the recommendations of a report on out-of-hours care ordered by ministers in 2010 had been fully implemented.

Meanwhile, BMA leaders hit out at the failure to assess NHS 111 services, warning that ‘variable and often inadequate call handling and triage’ could undermine out-of-hours care.

A total of 30 GP out-of-hours services were assessed by the CQC in the first wave of checks under the watchdog’s reformed ‘comprehensive and GP-led’ inspection regime.

Unacceptable variation

Chief inspector of general practice Professor Steve Field said he ‘did not have high hopes’ on the quality of out-of-hours care at the start of inspections, after a 2010 review that found ‘unacceptable variation’ in standards of care.

However, inspectors found the majority of providers were safe, effective, caring, responsive and well-led.

In-hours GP services could learn lessons from the use of audits and monitoring of care in out-of-hours, the report said.

Out-of-hours services used fewer locums than expected and were often staffed by local sessional GPs, and the services were praised for involving patients.

No serious concerns

Concerns were raised in some areas over storage of drugs, recruitment methods, equipment checks and how complaints mechanisms were publicised, but ‘no serious concerns’ were found.

The report found that 12 out of 24 recommendations from a 2010 report on out-of-hours care had been fully implemented. It suggested that not all CCGs were routinely monitoring out-of-hours performance, that some failed to benchmark services against other areas, and that nothing had been done to ensure providers shared concerns over staff working excessive hours, among other issues.

GPC chairman Dr Chaand Nagpaul said: ‘It is encouraging that these inspections show that in the vast majority of cases, the care that patients receive out-of-hours is safe, caring and effective.

‘However it is vital that GP out-of-hours services are not viewed in isolation. An omission from the report is NHS 111 which, as promised, must also be subject to inspections, given it is the front-end telephone service for patients calling out-of-hours.

NHS 111 warning

‘NHS 111 continues to provide a variable and often inadequate call handling and triage system, and will impact on the ability for GP out-of-hours services to provide optimal care.’

Dr Pallavi Bradshaw, a medico-legal adviser to the Medical Protection Society, told GP she welcomed the broadly positive findings.

‘Out-of-hours gets a bad press and I hope this will provide the public with reassurance and a pat on the back for doctors in the service who feel unappreciated,’ she said.

In particular, the finding that out-of-hours providers use audits to learn from significant events was good to see, she said. ‘We are always trying to promote the use of audits as educational tools. The more it becomes the norm, the better – not just using them when there has been a problem, but for learning is really positive.’

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