1. 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

2. 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

3. 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

4. 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

5. 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

6. 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%

7. 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

8. 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

9. 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

10. 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