Report from alliance of NHS workers says increased services at GPs and A&E units make it hard to know where to go
Patients face such a confusing mix of places to seek urgent health care or advice in England that their safety could be at risk, the government has been warned.
The services that had proliferated between GP surgeries and A&E departments made it difficult to define who was responsible for care as patients moved across organisational boundaries within the NHS, according to the NHS Alliance, representing commissioners, and the Primary Care Foundation, a company that advises on best practice.
Calling for the system of 24/7 care outside hospital to be simplified, their report said: "In addition to NHS Direct [the phone and web advice service], general practice, emergency departments and the ambulance service, a host of new facilities, including walk-in centres, urgent care centres, polyclinics, equitable access centres and GP-led health centres all offer a slightly different range of services available at varying times."
Most people on average only used out-of-hours services once every six years and A&E every three years, but such fragmentation without clean lines of responsibility put both staff and public at risk, said the report.
It also challenged the idea that it was better for patients and for organisations that treatment was prioritised under triage arrangements, saying these were often used to cope with delays caused by poor planning. "There is a real danger that the assumption is made that the assessed patient is safe to wait when, in reality, the condition of some patients can change rapidly."
A new 111 service planned to merge with NHS Direct over the next two years could potentially undermine the role of GPs, said the report, while successive governments' demands for frequent retendering of out-of-hours GP services were criticised too. "Tendering is expensive (estimated as at least £100,000 for the commissioner and for each provider involved) and disruptive and in some cases may lead to too much focus on the tender price rather than the quality, patient safety and the overall cost to the wider healthcare system."
The report said: "If a provider is to invest in a service, the time horizon needs to be long enough to make it worthwhile – or at least five years. Short contracts and short-term extensions will discourage investment in training, equipment, staff and systems." The Guardian
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