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Out-of-hours service failings prove costly

New out-of-hours services are far more expensive than the Government or PCTs predicted and are failing lamentably to hit quality targets, writes Joanna Clarke-Jones.

A damning report from the National Audit Office, due out later this week, reveals the Government underestimated the cost of providing out-of-hours services by £70 million, 22 per cent of the budget.

Ministers had estimated the cost at £9,500 per GP, but the true cost was now up to £13,000.

The resulting shortfall in cash given to English PCTs meant trusts were forced to raid other budgets and cut costs in order to pay providers, the report concluded.

Many PCTs also failed to

understand that the £6,000

GPs gave up to end their 24-

hour responsibility did not represent the cost of providing the service.

The result was mass confusion, plummeting service standards and poor value for money, the NAO concluded.

Widespread problems with contracts for new providers also left PCTs shouldering 'extremely high legal risks'.

The exceptions to the overall problems were those PCTs that had engaged with GPs early on in the process. These trusts 'reaped the benefit', it said.

Two years on from the first wave of GP opt-outs the vast majority of providers were still failing to hit Government quality targets relating to the speed of response to urgent and emergency calls, the NAO found.

Only 15 per cent of PCTs were meeting targets to provide emergency face-to-face consultations within an hour at a

primary care centre or the patient's home.

And almost nine in 10 were failing to provide an urgent consultation at the patient's home within two hours.

NHS Direct was severely criticised by PCTs and had lost several contracts as a result of providing a poor service.

PCTs said NHS Direct was 'unable to cope with demand' and was too expensive. Its nurses were also viewed as 'risk averse', the report concluded.

PCTs also reported that they were 'at the mercy of GPs' and rising rates for out of hours shifts were contributing to growing costs.

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