Archived decisions

Hampshire County Council Item 7

Health Review Committee: 21 September 2004

Hampshire, Southampton, Portsmouth and Isle of Wight Health Scrutiny Joint Committee: 13 September 2004

Briefing Paper: Out of Hours Services

Introduction

1. At the last meeting of the Health Review Committee a document from the Strategic Health Authority on Out of Hours (OOH) services was shared with members. This set out the current position for the delivery of services through identified cluster groups.

2. Members of the Committee have identified a number of issues of concern relating to OOH services. The recent publication of the inquiry into OOH undertaken by the Health Select Committee has clarified the potential impact of changes to these services and some of the issues that the Committee may wish to follow-up more locally.

3. This paper summarises the findings of the Select Committee, sets out the response to initial questions raised by members and highlights areas where further information may be of interest to the Committee.

House of Commons Health Select Committee Findings: July 2004

4. The Select Committee launched a short inquiry into the potential impact of the new GP contract on the provision of OOH in May 2004. This included an assessment of the implications for other services of the changes, financial considerations and skill mix issues. The conclusions and recommendations of the Committee are attached at Appendix One. The full report can be found on http://www.publications.parliament.uk/pa/cm200304/cmselect/cmhealth/697/697.pdf

5. The OOH period is currently defined as from 6.30 pm to 8 am Mon to Friday, all weekends and all public/bank holidays. As such it covers two thirds of every working week.

6. As well as securing medical cover outside the core working hours of GP services it also acts as a mechanism for managing demands placed on accident and emergency services, including ambulance services.

7. The Carson report, published in 2000 identified a model of OOH care in which PCTs developed a network of unscheduled care provision, bringing together OOH providers to work collaboratively with other health and social care providers.

8. The BMA estimates that 90% of GP will opt out of providing OOH cover by January 2005.

9. The findings of the Committee included

· The variable state of PCTs in readiness for taking on OOH responsibilities, and, in some circumstances that this transition is being managed by junior or inexperienced staff

· The need for an integrated and collaborative approach to unscheduled care across health economies. For example links with A&E, ambulance services, minor injuries units, walk-in centres, community hospitals, social services and NHS Direct to make sure that patients see the most appropriate healthcare professional for their condition

· The need for greater patient and public involvement in redesigning OOH services

· The need for patients to receive the medication they needed at the same time and in the same place as the OOH consultation.

· The time lag between the changes to OOH and the establishment suitably trained alternative health professionals. GPs from within the existing workforce will therefore be relied upon to provide the bulk of OOH provision the short to medium term. The availability of this workforce, and the impact of pressures from the European working time directive, has not been established

· The capacity of NHS Direct to provide the single telephone point for OOH care and advice before 2006

· The need for arrangements to be in place to provide primary care services on Saturday mornings. Anecdotal evidence that other services were being impacted on where OOH changes had already taken place, especially on Saturdays when local surgeries are now closed.

· Financial pressures on PCTs and a shortfall in funding to provide the new services and the impact this may have on the quality of service

10. In summary, although the report identifies a number of opportunities linked with the changes, the speed of implementation and funding implications represent significant risks that need to be managed.

Queries raised on behalf of Members

11. The Strategic Health Authority was approached for further information in relation to additional queries raised on behalf of members. These generated the following response

· All OOH will be from 6.30pm until 8am Monday to Friday and 6.30pm Friday until 8am Monday. A variety of cover will be provided via GPs, nurses, paramedics, emergency care practitioners, walk in centres, primary care centres and visiting services. Each patch has a GP led service supported by a variety of other professionals. Some cover will be by the PCTs, some by external organisations, agencies, co-ops and commercial providers.

· No staff are being employed from other European countries, however some PCTs are commissioning services from agencies (MTS - Medical Transfer Services)that do employ GPs from Europe. There has been national media coverage of MTS but the PCTs concerned have been meticulous in ensuring those GPs who will be working locally, are registered and have all the required scrutiny/checks before starting.

· All GPs will have equitable access to patient information

· With regard to quality assurance, each cluster will have or is developing clinical governance guidelines. In addition Medical Directors are in post and have performance audit and review policies and procedures in place to monitor the service in line with the Carson standards.

· Regarding concerns about Primecare (Southampton), a full and rigorous accreditation of Primecare took place in May. Primecare have been accredited until 30 June 2005

12. The Strategic Health Authority declined to provide the Committee with the cluster plans for OOH provision. Each cluster leader has therefore been approached for this information and 4 quarters monitoring report from each of the deputising services.

Further Information to be provided to Members

13. Members are invited to consider whether they may find the following information of interest.

· Given the experience of the Isle of Wight health economy as an exemplar in OOH provision, and the progress with providing a fully integrated model of unscheduled care, how is the learning from this being used to inform other clusters in Hampshire

· Given the significant deficit facing the NHS in Hampshire and the Isle of Wight, what assessment has been made of the costs of providing these services and is this funding available

· Is there a lead identified for taking this work forward in Hampshire and the Isle of Wight or is this being taken forward within each cluster

· What patient and public involvement will underpin the local development of OOH services. Who will lead this

· What account is taken of journey time if a patient is asked to attend a centre

· What happens if a patient does not have transport

· Is the appropriateness of referrals to 999 or A&E assessed? If so by whom

· What evidence is there that service providers are able to meet the quality standards for face to face consultations within the agreed timeframes

· What are the options for providing OOH forward within different clusters and how is this involving A&E departments, ambulance services, social services and other providers of unscheduled care

· How has the demand for these services been established to ensure that there is sufficient capacity in OOH provision

· Is demand mapped to identify peaks and troughs

· What account is taken of patients with special needs living in the community? How are these defined

· What account is taken of people receiving specialist care living in the community (e.g. people with mental health illness, people with chronic conditions, people who are terminally ill)

· What account is taken of the needs of patients who work and need non-emergency access either in the evening or at week-ends