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Out-of-hours providers curb GP visits and referrals

GPs working for out-of-hours providers are being placed under pressure to reduce their home visits and hospital referrals, amid warnings that financial pressures may be compromising quality of care.

Pulse has learned that a series of providers across the country have introduced moves to performance-manage GPs, in some cases accompanied by cuts to the number of doctors on call.

The moves have intensified the controversy surrounding out-of-hours care, following calls from the NHS Alliance and the Conservatives last week for GPs to take back responsibility for the management of services.

Providers have introduced performance management targets on criteria such as the percentage of house visits, length of telephone calls, referrals to 999 and hospital admissions, Pulse has learned.

Urgent Care 24 in Liverpool, Harmoni in central and southern England and SELDOC in south London all admitted introducing performance management criteria.

In Kent, the out-of-hours provider On Call Care has cut doctor hours by 5% after a PCT funding cutback, and brought in a performance management system aimed at make the service more ‘cost effective'.

In an email obtained by Pulse, Dr Mark Reynolds, chief executive and medical director of On Call Care - and former chair of the national association of GP Co-ops (NAGPC) - tells GPs: ‘Over the next couple of months you may notice a reduction in the numbers of doctors on shift. We have had to make this reduction to balance our budget, but also to try to get the most cost-effective use of our valuable doctors.'

‘Rota selection will not be influenced for a month or two, so those who feel they might be able to do things differently have a chance to make some changes.'

‘Dr Anxious can produce more than twice as much work for the system as Dr Perfect, and Dr Referalot can send four times the average to 999 or to hospital.'

The email goes on to warn GPs they risk being taking off the rota unless they meet requirements, telling them that the company is under pressure to reduce 999 calls and admissions because ‘PBC and commissioners are beginning to breathe down our necks'.

Dr Reynolds defended the move, telling Pulse PCTs now specified targets in their contracts, including appraisal of doctors' outcomes.

He added: ‘I am fully aware that statistics are a bit dangerous, but they will not be taken at face value.'

But Dr Ashish Dwivedi, chief executive of Seldoc, said performance management of GPs was essential given ‘doctors are the most expensive human resource in the NHS'.

Dr Mark Burns, chair of Urgent Care 24, said: Performance management is here whether we like it or not.'

But Dr Krishna Korlipara, former president of the NAGPC, said he was ‘very concerned' doctors might change their practice in the face of a ‘threat' to their job.

‘It's absolutely the worst possible way to go about it,' he said.

Dr Chaand Nagpaul, GPC negotiator with responsibility for out-of-hours care, said there was pressure on companies to ‘make efficiencies' because PCTs were struggling to manage the cost of running out-of-hours services.

OOH car How out-of-hours providers are managing GP performance How out-of-hours providers are managing GP performance

On Call Care
GPs performance-managed on triage outcomes, length of telephone calls, referrals to 999 and admissions

Seldoc
Monitoring number of telephone and face-to-face consultations, and length of calls

Harmoni
Has stopped using some doctors who were persistent ‘outliers' on issues such as over- and under-referring and time-keeping

Camidoc
Says it has operated performance management for some time
and ‘clinicians need to be engaged'

Urgent Care 24
Using computer data to look at productivity of clinicians and set to bring in annual performance review

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