Out of hours care: What PCTs need to do now

By Norma Beavers
"Out of hours care is improving but more must be done to get services integrated and open lines of communication between them. Patients also need to be better informed so that they do not equate out of hours care only with A & E Departments" so finds a new report by the Healthcare Commission.

Anna Walker, Chief Executive of the Healthcare Commission, said: “More could be done to get these services working together so that the right care is provided at the right time and in the right way.” In out of hours emergencies people often don’t know which services to use, and they have to repeat their story time and again because services don’t always share information effectively, she said. “Navigating between services can be difficult and confusing for patients and this can have a real impact, especially on people with more complex needs, such as older people and people with disabilities. Integrating services across a local area will help address these challenges. We are calling on the Government and healthcare organisations to renew their efforts to get the whole system working together so people can get the right care when they need it.”

 

The Healthcare Commission assessed how well services are managed by PCTs as commissioners of urgent and emergency services. Overall, 30 per cent of PCTs performed well across the managerial aspects of the review – this includes establishing networks, planning services, monitoring performance and engaging with patients and the public – 40 per cent scored poorly and the remainder were in-between. In particular:

•   almost all (98 per cent) of PCTs are part of a network of healthcare providers responsible for planning and delivering urgent and emergency care. But, only a third (34 per cent) of these networks appeared active and well developed. For the system of urgent and emergency care to further improve, these networks must work together to plan the effective delivery of services, says Walker

•   96 per cent of PCTs had an urgent and emergency care strategy in place or under development and had discussed it with the main local urgent and emergency care services. Not all had discussed these plans with other services involved in meeting people’s urgent care needs, for example, 30 per cent had not discussed it with NHS Direct and 42 per cent had not discussed it with local pharmacists

•   many PCTs (74 per cent) could be making better use of data on the performance of individual services in order to determine where further resources are required. For example, only 30 per cent of PCTs monitored levels of patient safety incidents in A&E departments. And while 25 per cent of PCTs monitored monthly use of urgent and emergency services by patients per GP practice, 44 per cent do not regularly monitor this aspect of care

•   73 per cent of areas had conducted public awareness campaigns to improve understanding of when to use particular services, but only 40 per cent of these campaigns had been evaluated.

 

The Commission makes seven recommendations to PCTs and Government to use the information in the review to improve the way services work together.

 

PCTs are urged to:

•   work with patients and the public to plan and deliver services, especially for people with more complex needs

•   have a clear plan for the delivery of integrated urgent and emergency care services across their area

•   ensure that they make effective use of information and collect whole-system data to inform the development of services.

 

Service providers need to:

•   fully engage with PCTs in addressing the results of the review

•   assist in the design and collection of whole-system data.

 

The Government’s role is also importanat and the Commission asks that government should:

•   ensure the organisational stability that PCTs and providers need to effectively plan future services

•   support the integration of services and simplify the way services are accessed, for example, through piloting of a single telephone number for urgent care services. A single telephone number has the potential to ensure fewer people attend the wrong services

•   the Government also needs to use consistent terminology to describe different types of services and make clear what each service provides. This should help patients know which particular service they should attend

•   the government should also review urgent care targets, which at the moment only measure individual parts of the system, and support the development of a whole-system approach, which measures performance from the time a patient seeks care to the time they receive it.

 

The Healthcare Commission’s review of out of hours care examines the whole system of out-of-hours GP services, NHS Direct, ambulance services, A&E, urgent care provided by GPs, and urgent care centres including Walk-in-Centres and Minor Injuries Units. The Commission assessed three key issues in each PCT area – how services are accessed and delivered; how services work together to provide effective and efficient care to patients; and how services are managed.

 

Services were rated over all 152 PCT localities since at the time of the review PCTs were responsible for commissioning local NHS Services. The review’s findings suggest the majority of services are performing well – 60 per cent of PCT areas achieved the top two ratings. Thirty-three percent of local areas are rated as ‘best’ performing (50 areas) and 27 per cent are rated ‘better’ performing (41 areas). Twenty-two percent are ‘fair’ performing (33 areas) and 18 per cent are rated as ‘least well’ performing (28 areas).