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Take ownership of commissioning out-of-hours services

The more closely involved GPs get with commissioning out-of-hours services, the better they can ensure that standards are maintained, says Dr Andrew Foulkes

The more closely involved GPs get with commissioning out-of-hours services, the better they can ensure that standards are maintained, says Dr Andrew Foulkes

In June 2007 West Sussex PCT informed its three out-of-hours providers of its intention to put the whole service out to tender. The trust wanted to develop a relationship with just one provider, to develop an integrated model of care and achieve better value.

As PEC chair at the PCT, I felt this would in every way provide a better service. A 2005/6 National Audit Office report1 raised concerns about the commissioning and provision of services, including cost. And the inquiry into the death of journalist Penny Campbell highlighted shortcomings in how services were provided – she spoke to eight different doctors working for her local GP out-of-hours service, none of whom realised she had septicaemia.

Quality of service was not an issue in West Sussex, where the three providers offered a good service and met most, if not all, national quality requirements. But we were keen to improve, so we devised a comprehensive commissioning process.

First:

• assess needs

• review current service provision

• identify any gaps in the service

• involve all stakeholders – clinicians,

acute trusts, ambulance services and the public – in identifying the strengths and weaknesses of the current service.

Second:

• design the service and the specifications

• develop the market and manage the procurement.

Third:

• manage the demand and ensure appropriate access to care.

Fourth:

• manage contract performance.

A comprehensive service specification, with clear objectives and standards, is essential. And it is important to bear in mind that tendering for out-of-hours services and managing the subsequent changes are time-consuming.

Dr Andrew Foulkes is PEC chair of West Sussex PCT

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