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Out-of-hours: How I picked the service off the floor

If anyone knows about the challenges of running an out-of-hours service, it's Dr Richard Clapp.

In December last year Dr Clapp, a sessional GP in Cornwall, was appointed medical director for Cornwall's out-of-hours provider Kernow Urgent Care Services, run by the multinational company Serco.

Ever since it took over out-of-hours cover from a local GP co-operative in April 2006, KUCS has been dogged by controversy, missing almost all of its quality targets and attracting dozens of patient complaints.

‘I would get stopped in the village post office and asked about it,' admitted Dr Clapp, who said the service was ‘sub-standard'.

In February, MPs held a special debate to discuss the service and Cornwall and Isles of Scilly PCT issued the company a 20-day improvement notice.

Faced with losing its contract, Serco was forced to make wide-ranging changes. ‘They ripped the call-centre apart, and put in some very up-to-date IT,' said Dr Clapp. Clinician hours were boosted by 10%, and the skill mix reviewed, with GPs taking on a greater role in triage.

Performance against key quality indicators improved rapidly as a result, and Dr Clapp believes the service is now ‘one of the best-performing services' in the country.

Improvement, though, came at a price. KUCS declines to say exactly how much was invested, but Dr Clapp conceded it was ‘significant', and ‘not the easiest thing to swallow'.

He added: ‘If you get something wrong, you've got to get it right. We now have got it right.'

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