NHS England criticised in out-of-hours GP report

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NHS England has been criticised in a report on out-of-hours GP services from the Public Accounts Committee.

The NHS' management of funding for out-of-hours GP services was criticised, as was the fragmentation of the system, lack of patient awareness and inability to forecast future need.

The report found the NHS has failed to ensure value for money in commissioning out-of-hours GP services, failed to analyse data to investigate poor services and has no up to date information to provide cost of service benchmarks.

Significant cost variations were also found with per case costs between £29 and £134, while ratings from patients of very good or fairly good varied between 49% and 86%.

The report also noted that much of the evidence used by NHS England was from the National Audit Office, and they could not provide data on the hourly rates paid to GPs.

Conflict of interest was also found to be a problem with GPs able to have interests in clinical commissioning groups and organisations providing out-of-hours services, and some contracts were being awarded without a competitive procurement process.

Problems with funding were also highlighted with a fragmented service where A&E departments are paid by activity while out-of-hours services are not.

Many patients are unaware of how to contact different options for urgent care with around a third of adults not having heard of the NHS 111 system to direct patients.

NHS England also lacks a model to predict the number of GPs needed in the future, with 6% of GP shifts currently filled by agency GPs.

The Rt Hon Margaret Hodge MP, chair of the committee of public accounts, said: "NHS England has not provided effective oversight of whether out-of-hours GP services are serving patients well and providing value for money.

Hodge added: "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.

"Looking to the future, the Department of Health and NHS England must develop information to be able to know whether there will be enough GPs to cope with the growing workload. NHS England cannot afford to wait for budgets to be set to predict how many GPs will be needed given the time it takes to train new GPs."

Dr Chaand Nagpaul, chair of the BMA's GP Committee said:"Many GPs are working hard to deliver out of hours to patients, but they are being undermined by an increasingly chaotic and underfunded system."

He added: "With patient demand continuing to rise, especially from an ageing population, this situation is only likely to deteriorate unless these fundamental issues are addressed.

"It is important that policy makers get a grip on this problem and properly integrate services so that patients have a clear, easily understood route to the right urgent care. We also need a proper programme of investment that gives GP services the staff and resources so that they can give the public the level of care they deserve."

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