Many primary care trusts do not always record whether out of hours patients go on to hospital and need to improve clinical coding in this area, according to a report by the Primary Care Foundation.

The assessment of out of hours services – during the Christmas and New Year period – was carried out by the foundation from 14 December 2009 to 10 January this year for 96 PCTs, all of which have been sent an individual report on their results.

It is the third “benchmarking” exercise on how out of hours demand is handled, how calls are prioritised, the time taken to assess and see patients face-to-face, clinical productivity and other measures. However, it is the first time the foundation, which carries out the exercise for the Department of Health, has focused on the festive period, rather than patterns throughout the remainder of the year.

As previously reported by HSJ, it will be the last time that the findings will be published without revealing the identities and performance of participating PCTs and their out of hours service providers.

Overall, the report found that despite the very high levels of demand over the bank holiday weekends at Christmas and New Year, patterns were predictable and most services coped with it.

However, many services still have progress to make in consistently prioritising urgent cases and meeting the national quality requirements on time to clinical assessment.

Efforts should be made to reduce “double assessment” as it extends the time to make a decision for the patient, the report concludes.

Foundation director Rick Stern told HSJ the information produced by the studies would be vital to current commissioners and GP consortia when they take over in the coming years.

He said: “This kind of information is the currency of effective commissioning because proper data about how services work allows you to take informed commissioning decisions.”

The report identified the following main areas in need of action:

  1. Many services falls short on time to definitive assessment, a long-standing national quality requirement, both for urgent and less urgent cases
  2. Reducing the level of double assessments makes things easier for the service and for patients
  3. Some services need to review prioritisation to ensure that they are not at risk of missing urgent cases when they are received
  4. Many services  do not always record whether patients go on to hospital – to provide good information on this key indicator it is important to improve clinical coding in this area
  5. In most services walk in cases are a comparatively small part of the case-load – but a small number sometimes wait a long time to be seen
  6. Improving consistency between clinicians is an important part of improving patient care and performance against the time standards. We have long argued that sharing information about case disposition and productivity with individual clinicians is an important way of doing this and the new tools in Adastra (the software used by the majority of services) simplify this process.

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