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Trusts need to scrutinise GPs’ out of hours services more thoroughly, says watchdog

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4075 (Published 05 October 2009) Cite this as: BMJ 2009;339:b4075
  1. Zosia Kmietowicz
  1. 1London

    Doctors working for GPs’ out of hours services need to be vetted more thoroughly to ensure that patients are treated safely and effectively, the NHS watchdog has said, after finding that one provider failed to scrutinise closely enough the quality of its care.

    The Care Quality Commission has said that it is not enough for primary care trusts (PCTs) to monitor only the time it takes out of hours service providers to answer calls. They must also look in detail at the quality of clinical decisions, the efficiency of call handling and triage, the number of unfilled shifts, the proportion of shifts covered by non-local doctors, and doctors’ training, to ensure that services are safe and meet patients’ needs.

    The commission investigated the out of hours provider Take Care Now and the service it delivered in five trusts, after the death of a patient, David Gray, in February 2008. He had been given 100 mg diamorphine, 10 times the recommended maximum dose, by a locum doctor the provider employed from Germany.

    Cynthia Bower, chief executive at the commission, said that although investigators are still in the early stages of their inquiries the initial findings may indicate a national problem.

    The investigation found that Take Care Now had reduced the chance of the original mistake happening again by withdrawing 100 mg doses of diamorphine. It had also made sure that schedule 2 controlled drugs, such as opiate based drugs, are stored and dispensed securely.

    But there are still some problems with the service that the commission said might be problems for other providers. For example, the service had difficulty filling shifts, dealt inconsistently in cases of suspected stroke, and had an inappropriate policy for managing drugs.

    “GP out of hours services provide vital care to people outside of normal surgery hours. As commissioners of these services, PCTs need to ensure people receive safe, quality care around the clock,” said Ms Bower.

    “Our visits to the five trusts that commission Take Care Now’s services showed they are only scratching the surface in terms of how they are routinely monitoring the quality of out of hours services. If their monitoring is not robust enough, they may not be in a position to spot early indications of potential problems or poor care.”

    The commission says that national regulations governing which doctors can work for the NHS are not being followed consistently, and this is being tackled by the Department of Health.

    Peter Walsh, chief executive of the charity Action against Medical Accidents, which has been supporting Mr Gray’s family, has called for more action. “The CQC [Care Quality Commission] statement is refreshingly different from the rather complacent reaction we got from some quarters when we first called for urgent action. However, a wider review is necessary. No one would design out of hours cover the way it is now if they started with a blank piece of paper and had patient safety in mind,” he said.

    The commission is continuing its inquiries into other Take Care Now facilities, which will include a survey of staff, an audit of call handling, and further inspection of how doctors are given permission to work for the NHS. The final report is expected to be published early in 2010.

    Notes

    Cite this as: BMJ 2009;339:b4075

    Footnotes

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