Urgent and emergency care service review Some interim results for GP out-of-hours services When a meeting, or part thereof, is held under the Chatham House Rule, participants are free to use the information received, but neither the identity nor the affiliation of the speaker(s), nor that of any other participant, may be revealed Chris Carter March 2008

The urgent care review and OOH services Out of hours services are a partnership between the provider the commissioner other services Out of hours services are an important part of urgent care and in answering the question how good are local urgent and emergency care services? The review is designed to support improvement will produce: a scored assessment, national and local reports benchmarking data Focus on the core service and Quality Requirements to allow comparability

Supporting Improvement Service level benchmarking data At PCT level for GP-OOH services Interrogate data using your local knowledge Focus for discussions with PCT and other services Compare software standard reports & charts drill down to data adaptable & flexible

Preliminary findings on GP-OOH services DRAFT FINDINGS BASED ON INTERIM DATA  Performance management  Clinical audit  Quality assurance When a meeting, or part thereof, is held under the Chatham House Rule, participants are free to use the information received, but neither the identity nor the affiliation of the speaker(s), nor that of any other participant, may be revealed

Performance management Most providers could provide PCT-specific data, but NQR 9/12 25% of providers did not report PCT specific performance NQR 8 17% of providers did not report PCT specific performance Most PCTs received PCT-specific data about all NQR performance, but 17% did not receive any PCT-specific data 23% did not receive a report against Standards for Better Health 34% received reports against NQR performance quarterly or less often Performance mostly partially compliant or better, but in a quarter of PCTs ≤ 80% of emergency home visits started within target ≤ 83% of emergency & urgent centre assessments started within target on average 10% of calls take longer than 1 minute to answer

Clinical audit Call handling 1% or more - 26% of providers Level of audit 1% or more - 26% of providers None (inc. no data) – 33% Target coverage 1% or greater - 89% of providers 26% achieved their target 11% achieved half their target Frequency Quarterly or better – 80% Frequency not specified – 12% Clinical assessment Level of audit 1% or more - 56% of providers None (inc. no data) – 17% Target coverage 1% or greater - 87% of providers 46% achieved their target 14% achieved half their target Frequency Quarterly or better – 68% Frequency not specified – 11%

Quality assurance Frequency & focus of monitoring Daily by 76% of providers Weekly by a further 12% of providers Monthly reports to PCT by 66% of providers and quarterly by another 27% Focus - peak time demand, initial response, completion times By subject Medication - monthly or quarterly, but not monitored by 26% of providers Frequent users - 19% of providers monitored annually or not at all Access to interpretation - 14% of providers monitored annually or not at all Patient Experience 80% of providers survey patients quarterly or more frequently 60% of providers report their results to their PCT annually of 6 monthly Patient Safety Incidents 83% of providers could provide information on PSIs but 71% of providers recorded no incidents at all

Good clinical indicators Good care requires good clinical management good operational management A good indicator will: have clinical value reflect actual performance be understandable by patients be supported by clinicians For example indicators developed by BAEM for A&E departments

Administering medication to palliative care patients An optional question: Based on measures developed by A&E departments A scenario from ‘Direction of Travel for Urgent Care’ (DH 2006) Focus on a patients with a significant clinical need Good test of out-of-hours care Could drive improvement About 35 responses covering up to 1,000 patients Median time from receipt of call 60 minutes Times ranged from 25 minutes to 2 hours

Next steps Improving data quality Opportunity for providers and PCTs to revise their data - March Ratification & Extenuating Circumstances - May Simultaneous publication in late June / early July of Scored assessments and local report National report Followed by Benchmarking data Service specific reports

Chris.Carter@healthcarecommission.org.uk 020 7448 9387