Safety fears raised as trusts cut funding for out-of-hours services

10 Feb 10

Almost two-thirds of PCOs that have renegotiated out-of-hours contracts in the last 12 months or are about to do so are reducing the amount they pay to out-of-hours providers, a Pulse investigation reveals.

The revelation comes as Department of Health report attacked the ‘unacceptable variation’ in out-of-hours care, amid widespread calls for a toughening up of the system following the Daniel Ubani case (see below).

The GPC said the contract data, released to Pulse under the Freedom of Information Act, demonstrated the pressing need for a ‘re-prioritisation’ of investment in out-of-hours care. Of 50 PCOs that responded to Pulse’s requests, 27 have renegotiated out-of-hours contracts in the past year or plan to do so in the next 12 months.

Of these, 18 provided details of contract costings, with 11 of these confirming they had re-tendered at a lower price or would do so. Other PCOs refused to release contract details on the grounds of commercial confidentiality.

Some PCOs, including NHS Mid Essex and NHS Kingston, said they were reducing costs to avoid duplication of services with GP-led health centres. NHS Redbridge said it was lowering the price of its contract ‘due to probable fall in demand due to increased access to GP extended hours’.

But all 11 PCOs indicated the need to gain greater value for money.

NHS Gloucestershire said: ‘A lower price was negotiated but the new contract supplies the same level of coverage, lower clinical risk and same quality of service as previous contracts.’ NHS Eastern and Coastal Kent said: ‘A reduced contract value is expected’ for its upcoming tender.

Dr Chaand Nagpaul, GPC negotiator with responsibility for out-of-hours, said it was ‘imperative’ PCOs re-prioritised their spending on out-of-hours in the wake of the Government’s report.

‘PCTs need to look again at the quality, provision and adequacy of out-of-hours contracts,’ he said.

He added: ‘The amount spent on out-of-hours is a very small proportion of a very large budget. There is no reason why they should not be able to re-priortise their use of funds. This is too important an issue for PCTs to ignore.’

RCGP chair Professor Steve Field, who jointly authored the DH report, said cost did not necessarily equate with quality, but warned: ‘There is a cost where standards could not be delivered, so reducing the cost of contracts is not a good idea. They should be looking at quality.’

Dr David Lloyd, joint medical director of out-of-hours provider Harmoni, which has 14 out-of-hours contracts, said: ‘There is no service PCTs are not trying to drive down costs for. There is a limit to how far you can substitute nurses for doctors and phone advice for face-to-face consultations.’