The CQC have published a report (22nd June 2018): The state of care in urgent primary care services presents findings from our programme of comprehensive inspections of urgent care centres, NHS 111 services and GP out-of-hours services.
The full report can be accessed here: https://www.cqc.org.uk/publications/major-report/state-care-urgent-primary-care-services
It shows that OOH services are for the most part good or outstanding: “We celebrate the fact that the majority of urgent care services in England are currently rated as good for the quality of their care, and provide some examples of good and outstanding practice”
It highlights the substantial challenges facing services – it drives home the message that services must have reasonable funding in order to deliver good services and the message that recruitment remains the other major challenge: “there is a growing risk in this area, with the value of contracts not reflecting the true costs of delivering them”.
On contracting, it highlights the system problems generated by the contracting process: “when an incumbent provider fails to win the tender, with a less experienced organisation taking over the contract, this leads to disruption, lost continuity and lost organisational memory and learning”
“We had no doubt that the complex commissioning arrangements (as well as providers subcontracting to other providers) had an impact on the quality of service delivered.”
“Another area that we identified is the limits placed on services by some commissioners. Often, providers wish to adapt their services to local needs, for example sending a nurse rather than a doctor to verify deaths, or moving to a more multidisciplinary model to support staffing; but they are prevented from doing so because of contractual restrictions on the services they provide.”
Lastly they highlighted both CHOC as outstanding and UHUK as the unifying force for good quality urgent primary care: “We also saw good examples of peer review and external audit – many of the providers that were members of Urgent Health UK (a membership organisation for social enterprise urgent care providers) were rated as good or outstanding and they submitted themselves to an external audit and committed to peer review of serious incidents. This included auditing call handling and clinical supervision, which led to regular quality improvement activity”