Exclusive: CCGs have begun remodelling GP out-of-hours contracts to enable direct referrals from new NHS 111 services and tie providers into targets for reductions in A&E attendances, Pulse can reveal.
More than half a dozen commissioning organisations across England have already placed GP out-of-hours services in their areas out to tender under revised specifications, with more set to follow as a host of contracts expire when CCGs become statutory bodies in April 2013.
The moves signals CCGs' intent to reshape out-of-hours services as they take on responsibility for commissioning care in England, with tender specifications designed to help CCGs meet QIPP targets to reduce A&E admissions and achieve greater integration with other local services.
In Staffordshire, where six CCGs are leading on the procurement of two new out-of-hours services set to commence on 1 April 2013, GPs are looking to reshape the service to try and reduce the burden on A&E by integrating it closely with the new 111 urgent care line.
A tender specification for the services, placed on the NHS Supply2health website, says they will be tendered ‘using a revised service specification incorporating the changes necessitated by the development of the 111 service'.
The advert calls for ‘a service that integrates with other providers to achieve an improved patient pathway and experience, high-quality service and reduction in unnecessary A&E attendances and admissions'.
Dr Chandra Kanneganti, a GP in Stoke-on-Trent and GP adviser for urgent care for Stoke-on-Trent CCG, explained that they wanted to reduce the 20% of out-of-hours calls sent to A&E that were inappropriate.
He said: ‘There is no point in having two triages, through 111 and again by out-of-hours providers. It makes the patient pathway very cumbersome. We said 111 should have direct access to the out-of-hours appointment slots, and assess whether [the call] needs a GP appointment in out-of-hours time. You may have to triage for some home visits, but otherwise you don't need any call handlers at all.'
‘Because 111 is going to drive these calls towards out-of-hours services, that should reduce A&E attendances. It's part of the QIPP agenda, but it's not the saving of money – it's the patient getting their care at the right place at the right time.We are talking about inappropriate attendances.'
Dr Kanneganti added the CCG was also stipulating that the service must ensure patients in the city were not travelling more than five miles if they required out-of-hours care: ‘We are not saying you need four or five centres, but centres placed where all the people have easy access and do not have to travel far.'
CCGs in NHS West Essex, NHS North Tyne and NHS Sutton and Merton have also placed their out-of-hours services out to tender under revised specifications, including working in conjunction with new 111 services.
A spokesman for NHS West Essex said: ‘The main enhancements to the current service will be direct referral into the provider from other services and improved palliative care arrangements.'
Andrew Gardner, chief executive of Harmoni, the country's largest out-of-hours provider, told Pulse: ‘We've seen about five or six out-of-hours services coming out [to tender]. There is more emphasis than I've seen previously on localisation and being fully integrated into area services.'
Dr Chaand Nagpaul, GPC negotiator, said: ‘This is an opportunity to ensure these contracts are fit for purpose in a way that they weren't in the past, with a more collaborative and integrated approach.
‘But this is quite a responsibility for CCGs, because they will need to commission against a backdrop of Government policy that is resulting in duplication and fragmentation – for example, the hasty implementation of 111.'
