NHS England has failed to provide effective oversight of whether out-of-hours GP services are serving patients well and providing value for money, MPs have said.
The agency also lacks the basic and essential information needed to understand why patients’ experience of and satisfaction with OOH services varies so widely and unacceptably across the country, as does the cost, the Commons Committee of Public Accounts continues, in a new report.
In July 2014, the proportion of people in each local area who rated their experience with OOH services as “very good” or “fairly good” ranged from 49% to 86%, while in 2013-14 the cost per case ranged from less than £29 to more than £134. However, the MPs say that NHS England has been unable to give them information on the specific reasons for these variations, or on the hourly rates paid to GPs – a key component of the service.
Nor is any up-to-date information available to allow Clinical Commissioning Groups (CCGs) to benchmark the costs of their services and how they perform against the national quality requirements; the only available data is over two years old.
“NHS England also needs to address the financial incentives which get in the way of different urgent care services working effectively together. Existing contracts provide incentives for A&E to hang on to patients and do not provide incentives to encourage out-of-hours services to take on more patients,” added Committee chair Margaret Hodge, Labour MP for Barking.
The PAC members also find “inherent risk of conflicts of interest” in the current system of commissioning OOH GP services. “For example, in Barnet, Enfield and Haringey, we understand a number of GPs who work for the CCGs also have shareholdings in the organisation that provides OOH care,” said Lady Hodge.
Some CCGs have awarded OOH contracts without a competitive procurement process and this, when coupled with the potential for conflicts of interest, increases the risk to propriety and value for money, she said, adding: “this issue should have been properly addressed before CCGs were introduced. CCGs must demonstrate how they are managing conflicts of interest and NHS England must assure itself that its guidance is being followed.”
The PAC also finds that too many people are unaware of the different options available for urgent and emergency care and of how to contact them. For example, about a third of adults in England have either not heard of NHS 111 or have heard of it but do not know what it is for, while a quarter have not heard of OOH GP services. As a result of the confusion, too many go to A&E when they do not need to, says the panel, and it calls on NHS England to set targets to increase public awareness of both services.
Finally, the MPs report that NHS England does not currently have a model to predict how many GPs will be needed in 2020 and that it does not intend to develop one until it has more certainty about the NHS budget to the end of the decade. However, they say: “in our view, NHS England cannot afford to wait for budgets to be set, given the time it takes to train new GPs.”