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Leaked report damns 'serious' out-of-hours failings

By Ian Quinn

Exclusive: Patients have been placed at risk of ‘significant harm' by a series of failings in an out-of-hours system spearheaded by NHS Direct, a confidential report leaked to Pulse warns.

An investigation into West Yorkshire Urgent Care Service, by the doctor who drew up the Government's national standards on out-of-hours care, identifies a catalogue of ‘serious' errors in the exchange of clinical information between NHS Direct and on-call GPs.

The report, dated 21 December, comes amid intense scrutiny of out-of-hours services, with the inquest into the death of a Cambridgeshire patient at the hands of a German locum set to deliver its verdict this week.

Report author Dr David Carson warns lessons from that tragedy and similar incidents, such as the death of London patient Penny Campbell in 2005, have not been acted upon.

In a disturbing echo of the Campbell case, his review finds the SystmOne mobile communication system used by the service failed to reliably update on-call GPs on patients' clinical histories or highlight when they had called on multiple occasions.

NHS Direct, which triages calls for the service, provided no way for doctors to see how many cases were being dealt with at any one time, meaning ‘doctors may be passing urgent calls into a system that does not have the capacity to respond'.

NHS Direct was also criticised for classifying as many as 60% of cases as urgent, leaving the system at risk of being overloaded and true emergencies missed.

Dr Carson, director of the Primary Care Foundation and a leading out-of-hours expert, concluded: ‘I cannot emphasise enough the serious concern I have over the issues identified.

‘Any system requiring so many manual workarounds to ensure patients do not get lost must be unfit. If information about previous consultations is not available to clinicians, these are serious risks. The deficiencies are more serious given the complex provider network… I have no doubt there is a risk of significant harm to patients.'

The investigation came after fears were raised by GPs working for Local Care Direct, a non-profit organisation providing out-of-hours care in the area alongside private firm Care UK.

SystmOne is used by more than 1,000 practices covering 14 million patients as part of the national GP Systems of Choice scheme. It is used for out-of-hours across the huge Leeds-Bradford urban centre. The report says the mobile version was prone to freezing and losing data. Logging on in a moving vehicle at night took 15 minutes, while GPs were forced to read tiny laptop screens using a six-point font and could not update records.

Last week, Pulse revealed the Primary Care Foundation's concerns about out-of-hours services using more than one provider. It warned: ‘We highlight the consequences in areas where the service is split or where misallocation of case type takes place.'

Dr Trefor Roscoe, a GP in Sheffield and long-term campaigner for better IT safety, said: ‘I'm appalled at these findings.'

Dr Mark Napper, out-of-hours clinical commissioning lead for the five PCTs that run the out-of-hours service with NHS Direct, insisted it had been ‘performing well', but admitted: ‘There is room for improvement'.

He said the system had been updated to ‘red flag' patients in contact in the previous 72 hours and check whether messages from NHS Direct had got through. But other key issues remain unsolved. Dr Napper said there was ‘no completion date' for providers to agree on a system to monitor numbers of cases in the system. GPs are still unable to update patient records using the mobile equipment, although this ‘should be resolved by the end of the month'.

Pulse raised the report's allegations with TPP, which produces the SystmOne software.

A spokesperson said: ‘TPP was pleased to attend the meeting when Dr Carson's report was received and able to correct errors in it. Where problems were identified TPP was pleased to provide rapid improvements. We are continuing to work with the service to deliver system enhancements.'

Despite requests, TPP did not clarify what the ‘errors' were.

In a later statement TPP added: 'Having reviewed in detail the comments made, it transpired that all the problems were to do with either misunderstandings of how the SystmOne software is designed to work, or were not software issues.

'Therefore, no changes were required to the software. Over 50 units are now using SystmOne Urgent Care across the UK and TPP are expecting in excess of 100 more to Go Live this year.

'TPP are proud to have been involved in this project as a further opportunity to extend the benefits of SystmOne as a fully integrated healthcare system.

'Since April 2009, over 544,000 Urgent Care contacts have been recorded on SystmOne. Approximately 240,000 of these benefited from the integrated care that the SystmOne solution already provides to over 15 million patients nationwide, as the full patient record was available at the point of care.'

The report found logging on in a moving vehicle at night took 15 minutes The report found logging on in a moving vehicle at night took 15 minutes OOH safety fears

• ‘Serious risk' information about repeat callers not being passed on to GPs
• GPs unable to update system, meaning a risk ‘up-to-date information not available'
• Mobile computers hard to read and prone to losing data
• Up to 60% of calls classified by NHS Direct as ‘urgent', placing doctors under ‘significant strain'
• No way for doctors to see how many cases were in system, threatening overload

Source: Report by Dr David Carson commissioned by NHS Kirklees

Read the leaked report in full

To download a copy of the full leaked report, please click here.

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