Doctors criticise privatised out of hours service in London

BMJ 2012; 345 doi: (Published 20 December 2012) Cite this as: BMJ 2012;345:e8610
  1. Zosia Kmietowicz
  1. 1London

The private sector provider of out of hours GP services Harmoni will be inspected by the health and social care watchdog for England within the next two months, amid claims that some shifts at hospitals across north London were so understaffed that the care provided was unsafe.

A spokesman for the Care and Quality Commission (CQC), which regulates all health and social care services in England, said that services provided by Harmoni would have to be inspected within a year of registering. As it was registered on 25 February 2012, inspections are imminent.

The out of hours service in north London has been severely criticised by doctors in the Guardian newspaper.1 They alleged that Harmoni’s cost cutting led to staff retention problems, shortages of clinical staff, and unsafe working practices.

Delays in seeing a 7 week old baby with a suspected respiratory infection at a Harmoni run clinic at the Whittington Hospital may have contributed to his death. The case has been reported to the CQC and the General Medical Council.

The GPs also claimed that Harmoni has manipulated its performance data, masked delays in seeing patients, and cut the length of appointments.

A previous investigation by the Guardian found allegations of understaffing, unsafe care, and data manipulation at the out of hours service provided by Serco in Cornwall.2 An inspection by the CQC in July this year found that Serco had failed on four of eight essential clinical standards, including those on employing enough staff and training them adequately.3 NHS Cornwall and the Isles of Scilly primary care trust later found that Serco had also given out false data on its performance 252 times.4

Harmoni was set up as a GP cooperative in 1996 in northwest London and became the United Kingdom’s largest provider of out of hours services. The company has also recently been awarded a string of contracts to run the new NHS 111 telephone services for non-emergency urgent care.

In November Harmoni was acquired for £48m (€60m; $76m) by the private healthcare company Care UK, which has a substantial portfolio of primary care, diagnostic, and elective care services across London and southern England.5 The deal meant that Care UK will now be providing unscheduled care to more than 15 million patients.

Harmoni refuted the criticisms of its London out of hours service. In a statement it said, “Our safety record, incidents, complaints, response times to patients, and rota fills all show that the service is safely run. At no point has it been the case that there were no overnight clinicians available to see patients or to make home visits. At no point has there been only one clinician triaging for the whole of the London service. At no point have our commissioners raised concerns about the safety of the service or suggested that Harmoni has been in breach of our contractual agreements.”

The primary care trust cluster for the area, NHS North Central London, which commissioned Harmoni, said in a statement that it monitored the services provided by the company on a monthly basis, including instances of sessions that could not be covered.

It said, “If we have concerns about their performance we raise it immediately. On the occasions where we have raised an issue with Harmoni we have found them responsive.”


Cite this as: BMJ 2012;345:e8610


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