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GP out-of-hours care exceeds CQC expectations

Chief inspector of general practice Professor Steve Field has welcomed the results of the first batch of inspections of GP out-of-hours services under the new CQC regime, saying they exceeded his expectations.

Professor Field said that although at the start he ‘did not have high hopes’ about the quality of out-of-hours care, he was ‘delighted’ that the inspections of 30 NHS GP out-of-hours services showed that ‘in most cases’ the care people receive is ‘safe, effective, caring, responsive and well-led’.

The checks did not result in CQC issuing any warnings or enforcement notices to the 30 out-of-hours services, although six of them were issued with compliance notices because of poor recruitment practices, with some services found not to be carrying out proper Disclosure and Barring Services checks.

The inspectors also found that some services were not following their own procedures on handing controlled medicines, some had inadequate systems for checking and monitoring equipment including oxygen and emergency medicine, and some were not properly telling patients how they could make complaints about the service.

Professor Field said: ‘Out-of-hours services are often considered to be higher risk than those provided during the day by GP surgeries and we know that some have seriously failed people in the past. At the start of our inspections, I did not have high hopes about the quality of out-of-hours care. However, I am delighted that these inspections have shown that in most cases the care people receive out of hours is safe, effective, caring, responsive and well-led.’

‘We saw lots of good practice and it’s important that these services learn from each other to improve their services. There are also some important lessons in here for all GP services to learn from, including those that only provide care during the day. This will help tackle the variation we saw and ensure that everyone receives a high quality service whatever time of day they need to access primary care.’

GPC chair Dr Chaand Nagpaul said the report was ‘encouraging’, however he warned that it did not include inspections of the NHS 111 service which ‘continues to provide a variable and often inadequate call handling and triage system’.

He said: ‘It is encouraging that these inspections show that in the vast majority of cases, the care that patients receive out of hours is safe, caring and effective. However it is vital that GP out of hours services are not viewed in isolation. An omission from the report is NHS 111 which, as promised, must also be subject to inspections, given it is the front end telephone service for patients calling out of hours.’

‘NHS 111 continues to provide a variable and often inadequate call handling and triage system, and will impact on the ability for GP out of hours services to provide optimal care. We believe that call triaging should be handled by experienced clinicians, not non-medical staff. There is also a pressing need for greater integration across the urgent care pathway to include walk-in centres, ambulance services, A&E units and social care.Failure to do so is to give a partial rather than a true picture of out of hours care for patients.’

The CQC said it will develop and test an approach to inspection of NHS 111 and urgent care services in a more joined-up way over the next few months, with more details due to be published later this year.

The 111 service has been extensively criticised by GP leaders for providing a lack of qualified medical staff, with NHS England launching a trial for GPs to work in 111 call centres earlier this year to support lay call handlers.