GP out-of-hours providers 'should run NHS 111'

Ministers should support GP out-of-hours providers to take over 111 contracts abandoned by NHS Direct, GP leaders believe.

NHS 111: call for GP out-of-hours leadership
NHS 111: call for GP out-of-hours leadership

Dr Mark Reynolds, chair of Urgent Health UK, an umbrella body for GP co-op successor organisations, said is was widely accepted that NHS 111 was being run best where it was was provided by not-for-profit GP out-of-hours organisations.

He called for flexibility from government to allow GP groups to take on the 11 regional contracts to be handed back by NHS Direct.

NHS Direct, the largest provider, threw NHS 111 into further chaos yesterday when it announced it would pull out of the service because its contracts were financially unsustainable.

The trust said it was spending around £13 per call to cover staff costs, but received between £7 and £8 per call from CCGs.

GPC chairman Dr Chaand Nagpaul said the announcement revealed 'worrying flaws' in NHS tendering and contracting processes.

But NHS England, which is overseeing the service and transition of NHS Direct’s contracts, said CCGs would have to retender.

Ministers are understood to favour ambulance trusts to take over the contracts, but Dr Reynolds warned against assuming the ‘de facto solution’ was to hand the service over to ambulance providers.

He said out-of-hours organisations could take on the contracts. ‘It is fair to say where it’s working around the country it is being provided by high quality GP out-of-hours services,' he said.

The service needs a ‘bit of flexibility in the model’, he added. ‘I think a sensible solution would be to set it up in parallel to out-of-hours services in areas where it has failed for a while with very close links, and then move towards a more integrated approach over time once it has stabilised.’

But Dr Fay Wilson, chief executive and group medical director at Badger, an out-of-hours provider in the Midlands, warned that commissioners could be set to parcel up the contracts and hand them to private firms and ambulance trusts.

‘It seems the NHS is intent on repeating history’, she said, ‘and the PBI [poor bloody infantry] will just have to do our best to pick up the pieces.’

She said local GP social enterprise groups believed NHS 111 should be integrated with their out-of-hours services. ‘So it is disappointing that the commissioners seem to be deciding to do something different.’

NHS Direct announced earlier this month it planned to withdraw from contracts in North Essex and Cornwall where services have yet to go live.

Now it will pull out of services in Somerset, Buckinghamshire, east London and the City, south-east London, Sutton and Merton, West Midlands, Lancashire and Cumbria, Greater Manchester, Merseyside and Cheshire.

In a report presented to the last board meeting of the organisation, Mr Chapman admitted its NHS 111 contracts were 'financially unsustainable', raising questions over its long-term viability.

GP revealed how NHS Direct identified concerns about understaffing and call volume forecasts weeks before the troubled roll-out of its 111 services.

Internal documents obtained by GP showed NHS Direct's clinical lead for NHS 111 in the north-west of England moved to a new role the day after it went live, leaving it without a full-time top clinical official.

In June NHS Direct said it was expecting financial penalties performance report showed it was answering less than a third of its contracted calls and running a £1.5m deficit.

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