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CCGs defy Hunt by planning to increase competition for out-of-hours GP care

More than one in five clinical commissioning groups are planning to “introduce” competition for out-of-hours primary care in the next year, an exclusive HSJ survey reveals.

The third quarterly HSJ CCG Barometer, sponsored by GatenbySanderson, asked CCG leaders if they planned to introduce competition in any areas in the next year and to name the four services most likely to be put out to tender.

Twenty-two per cent identified out-of-hours care.

The finding comes as health secretary Jeremy Hunt indicates he wants to return to a policy of GP practices having a more direct role in providing out of hours care. He is expected to call for the change in a speech on Thursday.

The survey suggests a large number of the 211 CCGs created by the government’s NHS reforms are – in contrast – planning to open the service to competition.

Out of hours primary care has generally provided by a chosen local, regional or national independent provider in each area. The quality of the services has been under question in recent years.

In the HSJ/GatenbySanderson survey, out-of-hours primary care was the fifth most chosen target for competition following musculoskeletal services (34 per cent), other community services (31 per cent), community diagnostics (26 per cent) and “care for several long term conditions” (24 per cent).

It is the first of the quarterly surveys carried out since CCGs took on their full powers as part of the Health Act commissioning reorganisation.

Ninety-four CCG leaders from 86 different CCGs, 41 per cent of the total 211, answered the survey during April and May. Ninety per cent were chairs or accountable officers and the other 10 per cent were other governing body members.

Readers' comments (8)

  • Michael Golding

    There is a tension between GPs not wishing to become responsible for OOHs, as in the old GP contract, yet retaining sufficient interest and control to ensure high quality services. A way to overcome this is to have local GPs involved in the management and delivery of OOHs services and the only way to make this happen is to ensure that rates of pay are sufficient to compete with other opportunities and to make those payments pensionable. Where this isn't the case, services will be staffed by nurses and doctors from out of the area. When OOHs services fail to deliver quality care, the outcomes for patients can be significant, and even tragic, and the knock-on effect to other services can be crippling. I would hope that the GPs working in CCGs will ensure sufficient funding is made available to support sustainable 24/7 urgent primary care services that are fully embedded within the local primary and community care community.

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  • Do CCGs decide on OOH contracts? Surely there is a conflict of interest. Beef up OOH contracts, increase the coverage hours, GPs do less work for the same money = result.

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  • Lets be honest about this to get the type of OOH service the patient expects and was delivered in 2004 by GP practices Cooperatives the funding needs to be increased by around 30/40% and local GP s paid around an Average of £125 per hour the correct rate for a GP working additional hours. Lets remember the contract was all about recruiting GPs on the understanding they never needed todo OOH. So reduction in good quality GPs who can respond to the very different clinical demands of OOH. CCGs pay up and take the flack of supporting your own but at least a chance of a good OOH service which reassures the patient they are getting a good service will use it and not divert to A&E etc. I understand that clinically it may not be essential but the patient has been told they must get a good service.

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  • CCGs have been told GPs cannot opt back in, they will have to tender for it. This is NHSE policy in London.

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  • Steven Burnell

    I wonder if some of the demand for emergency & OOH care from people with long term conditions or (for a little while) those recently discharged from acute care after a serious illness (e.g. stroke or heat attack) could be satisfied by extending the hours/ case-mix/ coverage offered by Community Matrons, thus leaving undiagnosed OOH calls for the Doctors? Effectively, could they benefit GP OOH just as they benefit acute hospitals & deliver a more appropriate & responsive service to boot?

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  • It would be helpful if Mike Farrar who I think lead the GP contract negotiations for TBs Govt. would publish the risk assessment that was done around the the implications for OOHs an its future staffing.

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  • Farrar came in at the end to tidy up the edges and get agreement on the 'bung', as the Londonwide LMCs called the final QOF settlement. You would need to talk to Ian Dodge about the underlying detail, and probably re-read the Carson report. The risk assessment would be difficult to replicate these days, there being fewer fag packets around.

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  • 1-1-1 needs a rethink for any OOH provision to be effective and more importantly safe. The errors in triaging some patients are unbelievable. Only this week an urgent 'warm call' sent through to GP OOH requesting a visit for 10 week baby who 'wouldn't stop crying'.This type of referral ties up OOH GP time which potentially causes a patient with a real need be diverted to hospital inappropriately. I think that SJBurnell suggestions above make a great deal of sense.

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