A successful out-of-hours care service relies on careful planning, a strong network of support for staff and a clear understanding of patient needs, explains John Harrison

Much has changed since Northern Doctors Urgent Care first started out as an out-of-hours care provider more than 10 years ago. Looking back, it is.hard to imagine a time when there were no quality standards to meet and all GPs were obliged to do out-of-hours shifts as part of their contracts.

The biggest change to occur in the field was undoubtedly the government's decision to hand control of out-of-hours services to primary care trusts.in 2004. However, other significant developments, including the Carson Report in 2000 - which set new standards for out-of-hours providers - have also had a significant impact on how Northern Doctors Urgent Care operates today.

A not-for-profit organisation, NDUC started its life as a GP co-operative in Northumberland, but restructured into its current form as a community benefit society after PCTs took responsibility for out-of-hours care. The group now handles out-of-hours care for patients in Northumberland, North and South Tyneside and Newcastle, with plans to expand out of the region.

Evolving structure

Before the new system under the PCTs, the organisation.was over-staffed. Nowadays, the group is more streamlined, with fewer doctors and more operational staff, including clinical and training managers - all handling duties that were previously covered by GPs. Under this system, dedicated teams keep an eye on performance, while the doctors focus purely on patients.

In its earlier years, the organisation ran a host of different centres across the area it covered, each operating independently. Today, the service is more tightly controlled, with all core staff being based at headquarters.

Northern Doctors Urgent Care welcomed the Department of Health's introduction of quality standards in October 2004, as they provided a solid benchmark for measuring the success of patient care. These requirements - such as making sure all home visits for urgent cases occur within two hours of a call - are easily met if simple procedures are in place.

For example, effective triage is vital if urgent cases are to be acted on within these timeframes. A key difference between working as a doctor during standard hours and working an out-of-hours shift is the need to assess a patient's condition over the telephone. GP training is very focused on face-to-face assessments, but out-of-hours doctors are often required to make an initial judgement without actually seeing a patient. As this can prove quite challenging, training is provided on telephone assessments.

Out-of-hours staff

During the organisation's.earlier years, the training it offered was rather ad hoc, but these days the group provides specific training for registrars, from an 'amber' level where they are.closely supervised, through to a 'green' standard when they are ready to receive remote supervision.

The introduction of formal policies and procedures is another way in which the organisation has improved its services. In the past, the group had no clinical guidance in place, whereas now, there are guidelines covering a range of issues, from care of children through to contingency plans in case the telephones go down in its call centre.

A recent patient survey commissioned by the group.showed that the vast majority of people preferred their out-of-hours services to be run by GPs. While nurses certainly play an important role in the provision of round-the-clock care, most patients would rather be seen by a doctor should they fall ill outside of surgery hours and so GPs form the majority of the staff base.

However, the organisation.works closely with district nurses on palliative care cases, exchanging advice on how to proceed with patients. Minor injuries nurses work at the organisation's.urgent care centres and the organisation provides them with help, including medical advice on specific cases.

Offering care for patients outside standard GP surgery hours clearly has its own challenges, not least the need to keep an eye on performance figures and the bottom line. Balancing cost-efficiency with a drive for high standards means neither the patient nor the taxpayer loses out.

John Harrison is general manager at Northern Doctors Urgent Care