'Huge variations' in out-of-hours care

'Too many variables' to explain variations in out-of-hours service costs.

Patients in parts of the UK are 18 times more likely to be hospitalised after a visit to out-of-hours services than patients elsewhere, a report shows.

The Primary Care Foundation (PCF) report compares GP out-of-hours services at 61 anonymous primary care organisations (PCOs), and found no clear reason for huge variations in cost and quality of services.

It found demands on services varied by a factor of two, but their costs by a factor of four. The proportion of patients later hospitalised varied by a factor of 18.

Out-of-hours variation

25% - 67%
Variation between UK PCOs in proportion of patients who receive out-of-hours medical advice by telephone

2% - 20%
Variation in proportion of home visits out of hours

£3.50 - £13
Lowest and highest cost per head of out-of-hours services

1% - 18%
Variation in proportion of patients later hospitalised.

PCF partner Henry Clay warned that neither the type of provider offering a service, nor the range of clinicians staffing it fully explained the variation.

While geography and demand clearly affected costs, other factors were at play, he said. 'Every PCO says "we're different, it's more difficult here",' he said. 'But I believe the minutiae of ensuring clinical decisions are made consistently are far more important.'

The DoH-backed report aims to allow PCOs and providers to rank their performance against their neighbours.

It found a vast range in the speed of response. One PCO took more than 20 minutes to assess urgent cases in more than 70 per cent of cases. But another assessed nearly 90 per cent of urgent and non-urgent cases in the same time.

GPC negotiator Dr Peter Holden warned that there are too many variables to usefully compare services. Comparing the costs in isolation was often meaningless, he added.

For example, nurse-run services may be cheaper, but more expensive to the wider NHS, because 'nurses are more likely to admit someone to hospital'.


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