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Fears over OOH standards amid 30-fold variation in 'urgent' cases

By Gareth Iacobucci

The standard of out-of-hours care has been called into question after new research found the proportion of out-of-hours cases classified as in need of urgent attention varies by as much as 30-fold across PCTs.

The startling disparity between PCOs, revealed in the first national benchmarking study of out-of-hours services, throws serious doubt on the validity of the Government's target to ensure urgent cases are dealt with within 20 minutes.

It suggests some PCOs may be only hitting the figure because they are classing only a tiny proportion of patients as in need of urgent care.

Out-of-hours operators at some trusts classed as many as 60% of cases as urgent, while at others the figure was as low as 2%, the Government-commissioned analysis reports.

There were also huge variation in the percentage of patients who are visited by a GP, with home visits occurring after 20% of calls in some trusts, but as few as 2% at others.

The analysis of more than 70 PCTs in England, by the Primary Care Foundation, heaps fresh controversy on the standard of out-of-hours services.

Henry Clay, who spearheaded the research, said the ‘extremes' in the variation raised concerns over the training of telephone operators and the ability of some out-of-hours providers to cope with the volume of calls they received.

‘It certainly shows there are big differences in what they do. I think the concern would be with the extremes. If it's very low, then are the call handlers missing some urgent cases and if it's very high, can the service really keep up?'

Mr Clay added that a lot of the discrepancies were down to some PCTs viewing out-of-hours as an extension of in-hours and some as an emergency service.

Under compulsory Department of Health quality requirements, out-of-hours operators are required to start definitive clinical assessment of calls classified as ‘urgent' within 20 minutes of a call being answered, and 95% of ‘non-urgent' calls within an hour.

Some out-of-hours services were providing telephone advice to up to two-thirds of patients, while in others fewer than a quarter of callers received advice by telephone.

Dr Krishna Korlipara, a GP in Bolton, and founder of the now-defunct National Association of GP Co-operatives, said he was concerned that the Government's standards were influencing judgements on urgent cases.

He said: 'I have absolutely no doubt that there is widespread concern about the inconsistant standards being applied. There is a tendendy to try and fob people off from seeing a doctor that night.'

Dr Chaand Napgpaul, GPC negotiator with responsibility for out-of-hours, said the ‘myriad of variations' in out-of-hours care was down to great differences in clinical involvement.

He said: ‘We believe that what makes a successful out-of-hours service is where there is closer clinician involvement in the way its run and secondly, to make sure you've got the highest level of triage by experienced clinicians. It should be a GP.'

The findings follow Pulse's revelation last year that GPs working for out-of-hours providers were being placed under pressure to reduce their home visits and hospital referrals in order to cut costs.

At the last LMCs conference, GPs voted narrowly for the profession to consider taking back commissioning responsibility for services, due to fears over standards.

GP visits and urgency of calls suffers from huge variation Proportion of GP visits and urgency of calls suffers from huge variation

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