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Government to bring in national model contract for out-of-hours care

By Gareth Iacobucci

The Government is to introduce a national model contract and tougher minimum standards for PCTs to use when procuring out of hours services, in order to create tighter controls on GPs providing out-of-hours care.

The announcement - which will also create more robust skills and knowledge testing for out-of-hours GPs - comes after a Government-sanctioned report into the standard of GP out-of-hours care revealed ‘unacceptable variation' in commissioning and service provision around the country.

Launching the report today, health minister Mike O'Brien also pledged to give GPs a bigger role in planning local out-of-hours services, but ruled out making it compulsory for GPs to commission, a central plank of the Conservatives' health manifesto.

The report, commissioned following the death of a patient given a fatal overdose by out-of-hours German locum GP Dr Daniel Ubani, said that although requirements were in place to provide ‘safe, high quality out-of-hours services', this was undermined by the ‘unacceptable variation' in implementation and monitoring by PCTs.

‘General Practice Out-of-hours Services,' has been published to coincide with the coroner's verdict on the death of David Gray, who was ruled to have been 'unlawfully killed' by Dr Ubani.

In a damning conclusion to the inquest, the coroner said the case amounted to gross negligence and manslaughter, and criticised weaknesses in the out-of-hours system.

It comes just a day after a confidential report leaked to Pulse revealed that patients have been placed at risk of ‘significant harm' by a series of failings in an out-of-hours system in West Yorkshire.

The Government report - produced following a review by the Department of Health's primary care tsar Dr David Colin-Thome and RCGP chair Professor Steve Field - makes a series of key recommendations for improving the commissioning and provision of out of hours care.

These include the requirements for PCTs to performance management arrangements in place for their out-of-hours services, and for the DH to issue guidance to PCTs to assist them in making decisions about whether or not a doctor has the necessary launguage skills.

The Department of Health has accepted all the recommendations in the report, but also pledged to go further in creating a model contract and tougher standards, the content of which will be consulted on before being introduced by the end of this year.

Mr O'Brien said: ''I am accepting all the recommendations made in today's report and setting out new measures that go even further. These will tighten existing controls and ensure that out of hours providers are employing competent clinicians, providing safe and effective care.'

'I expect all PCTs to act on these recommendations as a matter of urgency. It is unacceptable for any Trust to fail to meet its obligations on safety and quality of care.'

Dr Colin-Thome said: ‘The quality of out of hours care for most people is better than it was in 2004, but there is unacceptable variation in how services are implemented and monitored around the country.'

‘However, I am confident that by implementing the recommendations from our report, the system can be strengthened and vastly improved.'

Professor Field added: ‘The report outlines a number of important recommendations which will remind PCTs of their legal obligation to provide safe, high quality out of hours care.'

The report condemns 'unaccceptable variation' in GP out-of-hours care The report's key recommendations

• PCTs should review the performance management arrangements in place for their out-of-hours services and ensure they are robust and fit for purpose;
• The Department of Health should issue guidance to PCTs to assist them in making decisions about whether or not a doctor has the necessary knowledge of English;
• The Department of Health should develop and introduce an improvement programme for PCTs to support their commissioning and performance management of out-of-hours services;
• Out-of-hours providers should consider the recruitment and selection processes in place for clinical staff to ensure they are robust and that they are following best practice;
• Strategic Health Authorities should consider how they monitor action taken by PCTs in response to this report and in carrying out appropriate performance management of out-of-hours providers; and
• Providers should co-operate with other local and regional providers (both in and out-of-hours) to share any concerns over staff working excessive hours for their respective services.

Reaction to the report

Click here to read the latest reaction to the Government's report as it comes in.

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