When the contract for their jointly commissioned GP out-of-hours (OOH) service ended, NHS Liverpool and NHS Knowsley built extensive quality monitoring and patient safety measures into the new agreement.
How it works
The PCTs began re-tendering their shared OOH service by reviewing the successes and failures of the previous agreement and putting together a detailed contract specification spelling out how the service would be monitored.
Quality
The new contract stipulates that the provider will train GP registrars to provide OOH services, and sets out requirements around patient and public engagement.
These include using a patient survey and promoting awareness of the GP OOH service in conjunction with the PCT community involvement staff.
Patient Safety
Before the contract began PCT staff worked with their preferred provider, UC24, on a detailed mobilisation plan including checking drugs and medication management.
The PCTs and UC24 now hold monthly contract monitoring meetings comprising senior staff at UC24 and key PCT commissioning staff. Every month, this group views performance against national quality requirements for OOH, which are rated red, amber or green. If breaches of quality standards occur, UC24 provides a separate report. Results from the Royal College of GPs’ OOH toolkit and CFEP patient survey data are also fed into this meeting. A separate quality group also meets every two months to analyse the service from clinical perspective.
This group, comprising a PCT lead clinician and medical director, the deputy chief executive of UC24 and a PCT commissioner, has such high quality data that it can view individual GPs’ performance, spotting potential problems at an early stage.
The group watches trends to see whether patients are complaining more about a particular clinician or urgent care centre.
Service improvement
The PCTs and UC24 are in the final stages of implementing a CQUIN programme which will include patient feedback about the OOH service. The PCTs’ patient and public involvement teams are also working with the OOH service to consult the public.
What it has achieved
Despite the extensive performance monitoring procedures – and the fact that the service is provided exclusively by GPs with the support of a call handler – NHS Liverpool and NHS Knowsley’s OOH service is not significantly more expensive than many other OOH services. In fact, it is in the middle of the price range, according to the Primary Care Foundation’s OOH benchmark.
Commissioners report that performance has improved against national quality requirements, with the service often achieving green ratings across the board in monthly monitoring meetings.
They attribute much of their success to the strength of their relationship with GP providers at UC24.
Further information
If you would like further information on this case study, please contact Elizabeth Wade, Head of Commissioning Policy and Membership at elizabeth.wade@nhsconfed.org.