Out-of-hours tariff plan may undermine NHS integration

Fixing a tariff price for primary care out-of-hours services could undermine their integration with other NHS services, an expert has warned.

Out-of-hours services: could a tariff hamper integration of services? (Photograph: SPL)
Out-of-hours services: could a tariff hamper integration of services? (Photograph: SPL)

In June, senior GPs backed a motion at the LMCs conference in London calling for the GPC to press the government to agree a 'realistic minimum contract price to which commissioners must adhere' for out-of-hours services.

But NHS Alliance urgent and out-of-hours lead and Primary Care Foundation director Rick Stern has said a tariff for out-of-hours could block efforts to develop better links with other NHS services.

'It is best to get the service to work together, not pick out out-of-hours, when commissioners are trying to see how it fits in. People are looking at how you blur boundaries, not separating it out. A separate tariff would not be helpful,' he said.

But GPC member Dr Fay Wilson, who spoke in favour of the tariff at the LMCs conference, said a fixed price could make integration easier. She added that there was little consistency between out-of-hours services in different areas, because the lack of a fixed price created a 'reverse auction' in which commissioners picked the cheapest available option.

She said a fixed price would reduce variation because the tariff would be tied to a standard definition of work included in the tariff. 'A tariff would make it much easier to integrate. It would make it much more straightforward, because there would be consistency.'

Dr Wilson said the Health Bill promised there would be no competition on price in the NHS. 'But we've had it in out-of-hours for years,' she said.

Mr Stern said he hoped to publish a report in the coming months offering commissioners examples of how to improve the integration of urgent and out-of-hours services.

'There are great opportunities for clinical commissioners to take forward urgent care, without some of the restraints that existed in recent years,' he said.

Mr Stern added that although there was substantial variation in the standard of out-of-hours services, overall quality was higher than in 2004, when the new GMS contract was introduced.

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