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Independents' Day

Out-of-hours: Lottery over PCT services

PCTs are still struggling to run effective out-of-hours services three years after taking over responsibility, Pulse's investigation has shown.

Figures obtained from 114 primary care organisations under the Freedom of Information Act show patients face a lottery over out-of-hours care, with many trusts failing key Government quality targets.

Birmingham East and North – which uses a private provider – said it spent just £2.43 per patient per year, while at the other end of the scale, Pembrokeshire spent £17.62 per patient.

Trusts are increasingly turning to private providers in a bid to drive costs down. Some 35% of trusts now use private providers for out-of-hours services. The last published figures on out-of-hours care, based on Department of Health estimates from April 2005, suggested commercial providers accounted for 25% of all provision.

GP co-operatives, once the mainstay of out-of-hours care, are firmly in decline and are now used by just one in five trusts.

Dr Krishna Korlipara, founder of the now-defunct National Association of GP Co-operatives and chief executive of not-for-profit provider CMEDS, warned the number of co-operatives is ‘rapidly dwindling'.

CMEDS – based in Bolton, and the successor of Britain's first-ever GP co-operative – is to stop offering out-of-hours care after 30 years. ‘There were once 300 co-operatives – now there are fewer than 60,' said Dr Korlipara.

‘I worry for patient safety – unless local GPs are engaged individually and collectively in delivering out-of-hours, there will be a loss of expertise.'

Dr Alice Hodkinson, a GP in Cambridge, said out-of-hours providers were under constant pressure to cut costs: ‘They are struggling to stay afloat when money is more important than quality of care.'

Dr Elizabeth Nyholm, a GP in Birmingham, added: ‘PCTs have to accept out-of-hours costs money – they are only interested in the cheapest care and not quality standards.'

Trust figures show patchy performance against the department's 13 National Quality Requirements. Just one in five trusts in England reported 100% compliance with all 13 criteria – although the department now defines 95% adherence to each standard as ‘full compliance'.

How postcode matters on out-of-hours care

Average annual expenditure per patient on out-of-hours care

Expenditure in Birmingham East and North PCT

Expenditure in Pembrokeshire local health board

Trusts hitting 100% compliance on all 13 quality standards

Trusts missing 100% compliance in three or more standards

Trusts that have drafted in private firms to run out-of-hours services

Source: FOI results from 114 PCOS

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