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GPs face major clampdown over standard of out-of-hours provision

By Ian Quinn

GPs will have to meet rigorous new standards in the commissioning of out-of-hours services or face action from the new NHS Commissioning Board and the Care Quality Commission, the Government has revealed.

Details of the crackdown, which will see GP commissioners face much tougher regulation than has been the case for PCTs, emerged on the same day as it was revealed by the primary care tsar that there would be no extra funding for GPs' taking back responsibility for out-of-hours services in England.

Under the coalition Government's plans, GP commissioning consortiums would have to pass a raft of so-called National Quality Requirements, which are currently being reviewed to cover everything from the medical skills of providers to the ability of out-of-hours GPs to speak good English.

Both the new independent NHS Commissioning Board and the CQC are to be given new powers to step in to tackle failures.

The Government accuses GPs of benefiting at unfair cost to the taxpayer from being freed from responsibility of out-of-hours provision under the changes to the 2004 contract.

It says in future they will have to ensure that there is better training for out-of-hours GPs and assume the financial risk of employing private firms, or GP-led out-of-hours companies, among a range of accountability measures to apply to GP consortiums.

The plans are revealed in the Government's response to the health select committee's report on out-of-hours care, which was ordered by the previous administration after the death of the patient David Gray, following blunders by a German doctor working for Cambridgeshire out-of-hours provider Take Care Now.

The committee called for a major clampdown on PCT's recruitment and monitoring of out-of-hours services.

In its response the coalition says it agrees on the need for much tighter standards and that its plans to ditch PCTs will mean the onus falling squarely on GP commissioning consortiums.

‘There is no doubt that out-of-hours care needs urgent reform,' says the response, attacking Labour for showing ‘insufficient regard to securing value for money for taxpayers when they negotiated the out-of-hours GP service reforms in 2004. ‘

It adds: 'We are also concerned that since 2004 there have been failures on the part of some PCTs to monitor the quality of care and to assess and review contracts with out-of-hours care providers and failures on the part of some strategic health authorities to monitor PCT performance effectively. This situation has been compounded by a lack of clarity on responsibility between commissioners and providers and little or no integration of out-of-hours care with urgent care.'

The Government says GP consortiums will have to meet National Quality Requirements covering all contracts with out-of-hours service providers detailing the standards for quality of care, clinical governance and risk management.

‘We plan to address the failures of the previous administration by giving responsibility for commissioning and budgets to groups (or consortia) of GP practices in order to shift decision-making as close as possible to individual practices.

‘There are already National Quality Requirements (NQRs) for out-of-hours services which providers are contractually obliged to meet. These are currently being reviewed with a wide range of stakeholders in order to develop a stronger set of national, minimum standards .

‘It will remain the responsibility of those commissioning GP out-of-hours services to ensure that these NQRs are being met.

We agree with the Committee that those commissioning out-of-hours services should ensure that contracts with out-of-hours providers detail rigorous standards in respect of the recruitment, induction and training that doctors should receive.

The revamped national standards will be heavily influenced by the report produced in February by primary care tsar Dr David Colin-Thome and RCGP chair, Professor Steve Field.

They included a raft of plans to make commissioners more responsible for the recruitment, induction and training of out-of-hours doctors.

‘Commissioners must be satisfied that these standards are delivered by any sub-contractor or agency which providers may use, and this should apply to future commissioners of out-of-hours services, including GP commissioning consortia.'

GPs face major clampdown over standard of out-of-hours provision