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One in 10 primary care urgent care services in England not up to scratch

Despite value of these services commissioners don’t always fund them adequately, says regulator

Caroline White

Friday, 22 June 2018

While most primary care urgent care services in England are rated as good or outstanding, around one in 10 require improvement, reveals an analysis of the quality of provision, published today by health services regulator, the Care Quality Commission (CQC).

The report* found that most walk-in and urgent care centres, NHS 111 and GP out-of-hours services are rated as good (118) or outstanding (10). But around one in 10 (16) remain rated as requires improvement, while three are rated as inadequate.

As of the end of March this year, 147 urgent care providers had been inspected and rated: 64 urgent care and walk-in centres; 20 NHS 111 services; and 63 out of hours services.

The report highlights that effective urgent primary care is not only good for patients but also the wider healthcare system, because it eases pressure on other services.

This means that the value of its impact is greater than the cost of cost of providing it, but this isn’t always considered in complex commissioning decisions, says the report. As a result, not enough money is made available for these types of services.

The report notes that urgent primary care providers face other pressures, including staffing, which is compounded by the reality of unsocial working hours and high reliance on self-employed clinicians, and many providers find it difficult to access people’s medical records.

Voluntary sector groups also raised concerns that there is a lack of public information about which services to contact, and when, and that people need guidance to overcome an historic reliance on accident and emergency.

Professor Steve Field, CQC chief inspector of general practice, said: “Well-resourced and integrated urgent care not only provides safe, high quality care to people, but can also ease pressure on other areas of the NHS – particularly emergency departments during the winter period and other times of peak demand. These benefits should not be overlooked.”

It was “encouraging” he said that so many services were rated as good or outstanding and that commissioners and other services recognise the value that urgent care offers as part of integrated care for people in a local area.

“As CQC’s interim work reviewing local systems has shown, the relationship and interaction between services is vital to better patient experience and outcomes,” he added.

“The work already underway by NHS England is an important step in driving better care for people. However, there is more to be done to make sure complex commissioning arrangements and gaps in public information do not undermine care or undervalue these essential services,” he cautioned.

Niall Dickson, chief executive of the NHS Confederation, said: “We believe we have not invested at the speed or with the urgency required in new models of care in the community.

“It is shocking that over the past eight years spending on primary care in England has fallen in real terms – indeed from the mid-90s the number of hospital doctors has increased by 72 per cent, whereas in the same period the number of GPs fell by five per cent.”

He added: “What is important is that the patient is at the heart of any system design. We have welcomed the Prime Minister’s long-term funding settlement for the NHS. Unless we increase investment and reform the services that surround our hospitals, the whole system will fail.”

* The state of care in urgent primary care services. Care Quality Commission, June 2018

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