GPs who want to run out of hours services in their local areas should be awarded contracts without facing a ‘David versus Goliath’ struggle with large private companies, according to a report launched by the Royal College of General Practitioners (RCGP).
The RCGP says that many GPs are keen to have more involvement in the provision of out of hours services but they are being held back by the tendering process, which makes it difficult for small providers to compete with larger organisations on cost.
It claims that local practices risk being ‘priced out’ of the market and factors such as continuity of care should be taken into account as well as the cost of running services.
The College says that the regulations for awarding contracts should be clarified, and legislative changes made if necessary, to enable practices or groups of practices to take back their out of hours service without having to go through a competitive tender.
GPs were able to opt out of providing out of hours care as part of the 2004 GP contract, but out of hours care, led or run by GPs, still accounts for around 59% of all out of hours services in the UK.
The RCGP report, The Future of GP Out of Hours Care, also raises concerns that, despite efforts by GPs, patients have a low level of awareness about the availability of their local GP out of hours service. The latest GP Patient Survey found that only 45% of patients knew how to access this.
The College warns, however, that without an increase in the GP workforce, any increase in the provision of out of hours GP services would simply reduce the number of GPs available during normal working hours. GPs and their teams already manage 90% of all NHS patient contacts for just 8.3% of the overall budget.
The College and the National Association for Patient Participation are campaigning for an increase in the proportion of the NHS budget going to general practice from 8.3% to 11% by 2017 – and an increase of 10,000 in the number of GPs across the UK by 2020.
The RCGP report also proposes a range of other measures that general practice, if better funded, could implement to make out of hours care more patient-centred including:
- Responsibility for the promotion of out of hours services to rest with one body, so that patients can be better informed about the care and services on offer;
- Better patient data sharing across urgent and emergency care providers to improve continuity of care for patients – currently only 30% of urgent care centres provide all GPs in their local area with access to information about patients that they have treated, according to the RCGP; and
- Increasing GP training from three to four years to allow trainee GPs to gain more exposure to out of hours services, such as emergency care.
RCGP Chair Maureen Baker said: “Patients have a right to good quality care, both in and out of hours, but it is a little known fact that GPs are still involved in providing the majority of care and services for patients out of hours.
“GPs are keen to do more but those who are bidding for new out of hours contracts can find it difficult to compete on cost with bigger companies, some of which have little or no local GP input and involvement with the communities where they want to run services.
“Patients who need care outside normal hours can be particularly vulnerable and they need to have confidence in the care they receive from their out of hours provider – and how to access the service. It is very concerning that less than half of people who responded to the GP Patient Survey were aware of how to do this.
“GPs play a central role in their communities and many are well placed to provide care to patients outside normal hours. The recent report by the Care Quality Commission and the latest independent GP Patient Survey report very high levels of satisfaction among patients who saw a GP out of hours, both for the timeliness and the standard of care they received.
She added: “This is not about a return to all GPs working round the clock – that would be unsustainable for GPs and unsafe for patients.
“But if GP practices wish to work together to provide out of hours care for patients over large geographical areas, they should be given every encouragement to do so – and they must not be held back on the grounds of cost.
“Patient care and safety must never be compromised by cost and smaller providers should not have to face a David versus Goliath struggle for contracts.
“Demand for general practice services is increasing, both in and out of hours, due to our ageing and growing population. If general practice was appropriately funded and supported, it would allow us to increase the number of GPs across the UK by 2020 so that we can provide more care and services for our patients, whenever they need them.”
The Future of GP Out of Hours care and a document outlining examples of GP provided Out of Hours services can be found here: http://www.rcgp.org.uk/policy/rcgp-policy-areas/out-of-hours.aspx