OOH GP services – A Shameful reduction in standards, and increase in expense

ITV enquiry by Alice McShane and Produced by Sam Collins reported 22nd July 2015: ‘Shocking failures’ of after hour care

What happens if you fall ill out of hours? You’d hope you’d be able to access the same standard of treatment as you would during the working day. But is this really the case? A recent undercover investigation of our NHS Out of Hours service for ITV’s Exposure series has alleged “shocking failures ” in patient care. The programme sent Mark Austin and undercover reporter Alice McShane to a privately run Urgent Care Centre in West London and today they join us to tell us what they saw.

Nothing is shocking to us GPs who provided both normal and OOH (out of hours) services during most of our working lives. Some of the best and most rewarding years of my professional career as a GP was when we had a local GP co-operative. All the GP principals were involved, and we met to exchange ideas on improvement and treatment protocols, and helped each other with cover for sickness etc. When Mr Blair and the Labour government offered us “exit” in 2004 (BBC news 30th Jan 2007) without significant financial hardship we were stunned but grasped the offer… But the service for patients now is not as good as it was 10 or even 20 years ago.. And it costs a lot more in real terms… A shameful reduction in standards, and increase in expense… politicians are the guilty ones. They have created the system which is driven by lies and perverse incentives. Combined with rationing of doctors and nurses, It will lead to more litigation..

The program has some jargon on Key Performance Indicators (KPI) being fudged, and the evidence that OOH is more target friendly than patient friendly. Dr Mike Smith (A Hammersmith locum and also director of Haverstock Health, another OOH provider in North London) says “We have reached a point where disregard for basic processes to ensure basic patient care and safety are being ignored……. The whole thing only works if you have a GP trained in risk management at the front door.. Attitudes to patient care are questionable..”

It is not a requirement to have A&E experience to qualify as a GP, although it is desirable.. Nor is it a requirement to be able to read X rays, but there are few doctors willing to do this job, so relatively untrained personnel are appointed.

In the OOH centres, failing to meet targets means less cash, and less profit if the targets are not met. Therefore, the targets are “gamed” to ensure profit.. E.g. Early discharge within 4 hours, with unofficial follow up afterwards seemed commonplace..

A barrister, Simon Butler said “there are serious concerns about what Care UK contracted to do, and the reality of the service”… There is good evidence of understaffing at an average of 20% and as high as 50% undercapacity at peak demand times..

Catch up with the last week of This Morning on ITV Player

22/03/2013: Patients Association Criticise GP Appointments and Out Of Hours Service

Caring for your elderly and “continuous care”

2/5/2013: NHS watchdog severely reprimands Serco – a private company providing out of hours (OOH) GP services in Cornwall

3/10/2013: GP crisis. Out of Hours (OOH) and Out of Doctors – A&E Attendances

27/06/2015: OOH (Out of Hours) is very variable, and a disgrace. There is “No effective oversight”.

It was the best job in the world – for me 1979-2012 – but now there are not enough of us to cover the country

Setting sail in a boat already holed. The new government will fail unless it rations health. Proportional representation would be better than the inevitable mess to come..

Why are we not controlling cancer pain adequately in the community?

The True History of GP Out of Hours Services | A Better NHS

The NHS and reckless election promises. How about posthumous voting?

 

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This entry was posted in A Personal View, Commissioning, Gagging, General Practitioners, NHS managers, Post Code Lottery, Professionals, Rationing, Stories in the Media, Trust Board Directors on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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