PAC: out-of-hours health services cost varies too much

12 Nov 14
The cost of out-of-hours health services varies ‘unacceptably’ and NHS England lacks the information needed to understand why, according to the Public Accounts Committee.

By Marnio Donati | 12 November 2014

The cost of out-of-hours health services varies ‘unacceptably’ and NHS England lacks the information needed to understand why, according to the Public Accounts Committee.

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A report from the committee found that patients’ experience of, and satisfaction with, out-of-hours services varies significantly and unacceptably across the country, as does the cost.

It also concluded that NHS England had not provided effective oversight of whether the services are providing value for money.

The committee also called for more to be done to manage conflicts of interests when commissioners are also providers. The ‘perverse financial incentives’ which stop different urgent care services working effectively together, also need to be addressed, it added.

According to the PAC, the cost per case of out-of-hours treatment ranged from less than £29 to more than £134 in 2013/14. The proportion of people in each local area who rated their experience as ‘very good’ or ‘fairly good’ ranged from 49% to 86% in July 2014.

NHS England had a general understanding of the reason for the variations, but it had little specific information, the committee concluded.

‘A clear understanding of the reasons for variation and whether it can be justified is essential,’ the PAC said.

The committee also said that clinical commissioning groups should be able to demonstrate that they are managing conflicts of interest when commissioning out-of-hours GP services.

The design of the current system, where GPs can have interests in both the clinical commissioning groups that commission out-of-hours services and in the organisations that provide these services, brings an inherent risk of conflicts of interest, it concluded.

The committee recommended that NHS England test whether its guidance on conflicts of interest is being followed.

It should also seek documentary evidence that no one with an interest in the successful provider organisation was involved in the procurement process in contracts awarded since April 1 last year, the MPs said.

The committee also called for a redesign of urgent and emergency care to correct ‘mis-aligned incentives’ as well as targets to increase public awareness of out-of-hours GP services and NHS 111.

And the Department of Health and NHS England should develop a model for the GP workforce now, and use the results to inform discussions about the budget the NHS needs, and decisions about the number of GP training places required.

PAC chair Margaret Hodge said: ‘A clear understanding of the reasons for variation [in patient experience and costs] and whether it can be justified is essential, but NHS England could not provide information on the specific reasons for variation or on the costs of a key component of the service, the hourly rates paid to GPs.

‘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 onto patients and do not provide incentives to encourage out-of-hours services to take on more patients.’

Out-of-hours GP services provide urgent primary care when GP surgeries are closed, typically from 6.30pm to 8.00am on weekdays and all day at weekends and bank holidays.

According to the PAC, in 2013/14, out-of-hours GP services in England handled around 5.8 million cases at an estimated cost of £400m.


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