Private provider of out of hours care breached targets because of unfilled shifts

BMJ 2013; 346 doi: (Published 21 May 2013) Cite this as: BMJ 2013;346:f3299
  1. Zosia Kmietowicz
  1. 1BMJ

The private provider Harmoni was given until 18 May to spell out how it will increase recruitment to its out of hours service in north London after failing to meet the level of staffing demanded by the health regulator, the Care Quality Commission.1

The out of hours service provided by Harmoni covers 250 general practitioners in the London boroughs of Camden, Islington, Haringey, City, and Hackney—who serve a population of 1.2 million people.

The latest inspections, which took place on 11 and 12 March, followed claims by doctors in December 2012 that the service was so understaffed that it was unsafe.2 The death of a 7 week old baby from a suspected respiratory infection is being investigated after there were delays in the baby being seen at a clinic run by Harmoni at the Whittington Hospital.

Harmoni was set up as a general practice cooperative in 1996 in northwest London, and was acquired for £48m (€60m; $76m) by the private healthcare company Care UK in November 2012.3

In their examination of Harmoni, the commission inspectors found that between November 2012 and the end of January 2013, the service breached four national targets related to delivery of out of hours care. It triaged just 85% of urgent calls within 20 minutes and 62-83% of non-urgent calls within 60 minutes, and carried out 83-88% of urgent home visits within two hours and 82-86% of routine home visits within six hours. The national standard for all these targets is 95%.

Harmoni told the commission that in December 2012 it had been unable to fill 33 shifts and had used 115 hours of agency staff. In January 2013, there were 295 unfilled hours resulting in unfilled shifts, and Harmoni used 240 hours of agency staff.

Inspectors passed the service on all the other eight standards against which they judge providers.

Harmoni told the commission that it had problems recruiting general practitioners and covering shifts, especially when doctors were unable to work at short notice. This happened on 52 occasions during the three month inspection period. One doctor had cancelled their shifts six times and another seven times, but Harmoni kept booking them because they had no other options while they looked for more staff, the report said.

The commission concluded that there were not enough qualified, skilled, and experienced staff to meet people’s needs, which presented a moderate effect on people who used the service. It will review that the necessary action has been taken.

Vivek Muthu, director of healthcare at the Economist Intelligence Unit, which undertakes economic and business research and analysis, said that the report highlighted concerns about introducing competition into healthcare. “By fostering a competitive market for healthcare provision, policy makers hope to drive up quality and drive down costs. However, quality in healthcare services can be hard to measure. So, some argue, commissioning decisions can end up being unduly influenced by cost rather than quality. This problem may be compounded if the payer function is not supported by clinical quality metrics, adequate resources and capacity, and appropriate contractual levers,” he said.

A spokesperson for Harmoni said: “There is absolutely no suggestion, in either the Care Quality Commission report or in the performance of the service, that the out of hours service is, or has been, in any way unsafe.”

The company was working with commissioners to meet the national standards set out by the Department of Health. It added: “Performance regarding face to face consultations and visits is now fully compliant with NHS standards and significant improvements have been made in meeting triage targets.”


Cite this as: BMJ 2013;346:f3299