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Not-for-profit GP providers cheaper and rated higher than private out-of-hours firms

Exclusive: Private out-of-hours services are more expensive and rated worse by patients than those delivered by not-for-profit alternatives such as GP co-operatives, a major Pulse analysis reveals.

Companies often matched the performance of not-for-profit and NHS providers on the National Quality Requirements under which contracts are monitored, but lagged significantly behind on separate patient satisfaction scores.

Harmoni, the country's largest out-of-hours provider, performed significantly below average not only on patient satisfaction but on key requirements to assess urgent cases within 20 minutes and see them face to face within two hours.

Our findings come from a detailed breakdown of the first ever Primary Care Foundation benchmarking exercise to name individual providers, and will seriously challenge the growing dominance of private firms in the out-of-hours market.

The analysis looked at five indicators across 81 out-of-hours services, 32 provided by not-for-profit organisations, 27 in house by the NHS and 22 by private firms – 12 by Harmoni.

Private providers were paid an average of £8.11 per head compared with £7.39 for not-for-profit organisations and £9.10 for NHS providers.

But just 59.5% of private services were rated good or very good by patients, compared with 65% for not-for-profit services and 64.7% for the NHS.

Just 51.7% of Harmoni's services were rated good or very good by patients, although the company was cheaper than some private firms, at £7.93 per head.

Patients' different views of services were only partly reflected in performance on
key National Quality Requirements. Private providers saw 91.2% of urgent cases within two hours – with Harmoni scoring just 81.4% – compared with 95.3% for not-for-profit and 91.6% for NHS trusts.

But private providers gave 84.1% of urgent cases definitive assessment in 20 minutes, compared with 82.4% for not-for-profit providers and 82.7% for NHS trusts. Harmoni averaged 74.3%.
The Primary Care Foundation said there was too much focus on fulfilling National Quality Requirements, and urged commissioners to also consider patient satisfaction, audits of clinicians and integration of services.

Henry Clay, director at the Primary Care Foundation, said: ‘Sometimes there are good reasons why the service is where it is, but in other cases I hope they will think how they can improve.'
Mike Barradell-Smith, marketing director at Harmoni, said: ‘This benchmarking process took place during late 2010 and any issues raised have been discussed with PCTs and, where appropriate, action plans implemented. Because of the nature of our business, Harmoni typically wins contracts from failing out-of-hours  providers, so our average performance against some measures is dragged down while we stabilise and improve. But we have the strongest governance arrangements in the sector.'

Chris Wright, chief executive of not-for-profit provider Devon Doctors, which achieved the country's highest patient experience scores and was significantly above average on other quality indicators, said: ‘As a social enterprise, our ethos is to treat patients like people, rather than as an inconvenience.'

Dr Peter Holden, GPC negotiator and a GP in Matlock, Derbyshire, said: ‘Not-for-profit, John Lewis-type co-ops are the way to do out-of-hours. If you are insisting on a dividend, there's only so much money to run the service.'

Click here to see the fully benchmarked data from the Primary Care Foundation