Patients at risk over failings in GP service

Weekend and evening services could be missing urgent cases and there is a "wide variation" in how patients are defined as needing urgent care.

The research, which covers almost 100 primary care trusts (PCTs) in England, was commissioned by the Department of Health and funded by PCTs. It covered Christmas week last year when demand was high, but was no more than expected and "followed a predictable pattern".

Researchers found, however, that most services were failing to fully meet one or more key standards on out-of-hours care laid down by the NHS.

Performance in out-of-hours care is sometimes poor because of variations in staff ability and the way individuals practise, which needs watching more closely.

"The service performs well when some staff are on duty and less well when others are working," according to the Primary Care Foundation.

More than one in 10 urgent cases are not assessed clinically within the required 20 minutes but the figure varies from around 40 per cent assessed within 20 minutes to almost 100 per cent assessed within the timeframe.

Almost a quarter (24 per cent) of less urgent cases are not assessed within the required 60 minutes and there is widespread variation.

The Department of Health said out-of-hours providers "have to demonstrate 100 per cent compliance" with these standards – where average performance is more than 10 per cent below, services are regarded as "non-compliant".

Even some units with small numbers of urgent cases still "fall well short" of the requirement on assessing patients, the document said, and it warns: "Some services have so few cases identified as urgent on receipt compared with others that we doubt they can demonstrate they have a clinically safe and effective system for prioritising calls."

The report added: "Not only is there wide variation between services in propensity to define cases as urgent, there is also inconsistency between call-handlers and clinicians, and between individuals."

Across all services, 47 per cent of cases result in telephone advice, 38 per cent are seen at the unit and 15 per cent involve home visits.

England's out-of-hours service is currently run by local trusts, which commission services from in-house teams and private firms. A change to the GP contract in 2004 meant family doctors were able to opt out of providing out-of-hours care in return for an average 6,000 drop in salary.

Out-of-hours care has been heavily criticised. Journalist Penny Campbell died in north London in 2005 from multiple organ failure after she consulted eight doctors over the course of four days. And the General Medical Council struck off a German doctor employed by a private company after he killed a pensioner in Cambridgeshire with an overdose of painkillers on his first shift in Britain.

Investigations revealed that he had a poor command of English, had slept little that night, and "serious failings" were discovered in the company's use of diamorphine, which had also been implicated in two other overdose incidents.

A Department of Health spokeswoman said the coalition Government was determined to urgently reform out-of-hours care which was why commissioning of local health services was being handed over to GPs.