Viewpoint - Who's afraid of in-hours audits?

Out-of-hours data is already being used to throw more light on GPs' work in surgery hours, says Dr Donald Law.

Dr Law: 'All my work is out-of-hours so is audited already'
Dr Law: 'All my work is out-of-hours so is audited already'

I am in favour of audits of GP in-hours work similar to those out-of-hours services must provide.

Until the Care Quality Commission's report in 2011 on the out-of-hours locum who accidentally administered a fatal diamorphine overdose, few PCTs realised how reports that out-of-hours providers are obliged to provide can be used to monitor practices in-hours.

Statistics and reports previously glanced at and filed, are now being combined with details from acute trusts to place practices in league tables showing their patients' use of out-of-hours and A&E attendances.

This makes it possible to infer the daily availability of appointments at practices, including during extended hours, from the number of patients phoning the local out-of-hours service each evening and at weekends.

It is not just the practice that can be monitored: the national quality requirements (NQRs) for out-of-hours services include quarterly clinical and prescribing audits of individual GPs doing shifts.

PCTs can monitor the number of hours worked for an out-of-hours service and ensure that unsafe practices, such as working a night shift before a day at the surgery, are discouraged. Most GPs working for on-call services find the NQR audits welcome. They can be used in appraisal evidence, showing the GP's clinical work has been audited against standards set by the RCGP.

However, PCTs have used these audits and other statistics from hospitals as evidence to confirm concerns about some GPs' in-hours work.

On more than one occasion this has led to referral to the GMC. In my capacity as a medical adviser on out-of-hours services, I have had to comment on the GP's performance to a GMC fitness to practise investigator.

The audits are to ensure GPs provide a safe service out-of-hours. As yet there are no in-hours equivalents. I am sure that as GP appraisers see more NQR audit reports, their usefulness will also become apparent to GP consortia.

Stumbling block
What is to stop these audits being applied to in-hours work? The major stumbling block is the logistics of auditing clinical practice at GP surgeries where recorded telephone consultations data is not readily available.

Also, most GP clinical software does not include the relevant audit tools and a network of GP clinical auditors would need to be recruited, paid and their skills maintained. But there were similar concerns when GP appraisal was first suggested.

Where do I stand on this issue? As I work exclusively in out-of-hours, all my work is audited already. I feel most GPs will agree it is difficult to object to an audit produced by the RCGP, that provides a fair method of assessing clinical practice, and is used in out-of-hours services and GP registrar training.

When revalidation happens, such a tried and tested system can only help GPs.

  • Dr Law is medical adviser on out-of-hours services for the East of England Ambulance NHS Trust in Essex

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