Health: Out-of-hours Care

Statements

Baroness Thornton
My right honourable friend the Minister of State, Department of Health (Mike O’Brien) has made then following Written Ministerial Statement.

Following concerns about delivery out-of-hours primary care services being raised in summer 2009, I met with primary care professionals in order to understand the issues in more detail and consider what action might be taken to improve out-of-hours services to patients. The broader context to this was that in June 2009, the Care Quality Commission (CQC) began an investigation into the out-of-hours (OOH) primary care services in five primary care trusts (PCTs) provided by the company Take Care Now. The enquiry was prompted by the tragic death of a patient in February 2008 after he was administered 100mg of diamorphine by a locum doctor from Germany.

CQC published an update on its independent enquiry in October 2009. This included a preliminary conclusion that all PCTs needed to improve their monitoring of out-of-hours services, particularly of the quality of the service patients receive. Dr David Colin-Thomé, National Clinical Director for Primary Care subsequently wrote to PCTs in support of the CQC’s recommendation in their update report and reminding them of their responsibilities around performance management of OOHs providers and ensuring general practitioners working in OOHs are fit to practise that role.

I also asked Dr David Colin-Thomé, National Clinical Director for Primary Care at the Department of Health and Professor Steve Field, Chairman of Council, Royal College of General Practitioners, as two respected and experienced general practitioners, to jointly lead a review of current arrangements for the local commissioning and provision of out-of-hours services. In so doing, they considered the commissioning and performance management of OOH services; the selection, induction, training and use of OOH clinicians; and the management and operation of medical performers lists.

I have published Dr Colin-Thomé and Professor Field’s subsequent report today and placed copies in the Library. The report sets out a number of recommendations including:

PCTs should review the performance management arrangements in place for their out-of-hours services, ensure they are robust, and fit for purpose;
 

the Department of Health should issue guidance to PCTs to assist them in making decisions about whether or not a doctor has the necessary knowledge of English to be admitted to their medical performers list;
 

the Department of Health should develop and introduce an improvement programme for PCTs to support their commissioning and performance management of out-of-hours services;
 

out-of-hours providers should consider the recruitment and selection processes in place for clinical staff, ensure they are robust, and follow best practice; and
 

strategic health authorities should consider how they monitor action taken by PCTs in response to the report and in carrying out appropriate performance management of out-of-hours providers.
 

The report’s recommendations are an important reminder to PCTs and providers of their obligations to ensure safe and effective out-of-hours services for patients and as such—insofar as they apply to the Department or the National Health Service—I have not only accepted them in full but I am today announcing further improvements to out of hours GP services.

I will:

review the existing national quality requirements in order to develop a stronger set of national, minimum standards which all out-of-hours providers will be required to meet;
 

introduce a new national model contract for out-of- hours provision, based on the new national minimum standards, to reflect the characteristics of existing high-quality provision;
 

through stronger performance management by SHAs, tighten existing controls to ensure PCTs are meeting their legal obligations through commissioning and contracting arrangements and that providers are employing competent clinicians to practice as GPs in primary care out-of-hours. It is also my intention to direct PCTs to review their current procedures and to ensure that they have a clear policy in place for assessing the language knowledge of persons applying for inclusion on the local perfomers list; and
 

require PCTs to increase their engagement and involvement of GPs in ensuring high-quality provision of out-of-hours services through, for example, Local Medical Committees, RCGP groups, RCGP faculties, clinical executive groups, local and with practice-based commissioning consortia.
 

We will be consulting relevant stakeholders on these proposals including the British Medical Association, the Royal College of General Practitioners, the NHS Alliance and the National Association of Primary Care.

In the meantime, officials in the department will continue working with the NHS to ensure they are implemented. In particular, to continue to implement the recommendations of the Tackling Concerns Locally: the Performers List system, A review of current arrangements and recommendations for the future, published in March 2009.

The NHS chief executive Sir David Nicholson will be writing to NHS organisations to bring this report to their attention and seeking assurances that they are meeting their obligations as set out in the report. At the same time, the department will issue new interim guidance to PCTs to assist them in complying with their obligations to ensure all doctors admitted to their performers list have a satisfactory knowledge of English.

Baroness Thornton
My right honourable friend the Minister of State, Department of Health (Mike O’Brien) has made the following Written Ministerial Statement.

A report on the current arrangements for the local commissioning and provision of out-of-hours primary care services has today been published by the Department of Health and placed in the Library.