GP Out-of-Hours Services to be Inspected and Regulated

March 13, 2014

Medical careWhat changed?

Over 10 years ago most Practices were part of a local on-call doctors’ service which enabled patients to get through to a GP when their surgery was closed from 6.30pm to 8.00am on weekdays and all day at weekends and on bank holidays with a simple phone call. However GP’s have been blamed for the crisis in out-of-hours health care since the changes to GPs’ contracts made in 2004, allowed them to opt out of treating patients outside normal office hours.

Can we cope with increasing patient demands and expectations?

Following the changes, about 90 per cent of GPs stopped providing emergency cover and patients had to rely on phone services, agency doctors or hospital visits. In 2004/05, 17.7 million people used England’s A&E departments. By 2012, that had risen to 21.7 million.

Although GPs had their salaries reduced by about £6,000 if they stopped providing care out of hours, other changes to the contract meant that average pay rose by a third, with claims that many GPs earning six-figure salaries. There has been a constant battle by the government to overturn this decision and one which GP’s have understandably strongly resisted, but with income decreasing faster than ever and a shortage of GP’s how is it possible to provide the same local service 10 years on?

It’s widely recognised that we need more preventive treatment and community-based care with services working together to provide the right support at the right time, particularly for the vulnerable and the elderly. The problem is that we as a society have come to expect all services remain open and accessible 24 hours a day, 7 days a week, because if we want something we want it now and we’re not happy to be told to wait.

The NHS as a whole is under considerable strain, mainly because the with increasing health needs the public is much more demanding and no longer self manages their minor illnesses such as coughs and colds, they still prefer to seek reassurance from a GP and expect to walk out of the consulting room with a prescription in their hand. They feel ‘fobbed off’ if the GP simply advises they go home and rest but the reality is there’s very little the GP can treat in these cases.

A new approach to inspections

However, there are many genuine cases of patients needing access to a GP once the surgery doors have closed, the CQC are completing their 3 month review of GP out-of-hours service and a new approach to inspections of GPs and GP out-of-hours will start next month.

The inspectors will look at how well the service responds to patients’ needs and consider the quality of communication between out-of-hours care and other local services, including GP practices, care homes and emergency services.

Key changes

  • Better, more systematic use of people’s views and experiences, including suggestions and complaints.
  • New expert inspection teams including trained inspectors, clinical input led by GPs and nurses, practice managers and GP Registrars.
  • Inspections of GP out-of-hours services to be incorporated into CCG area programmes.
  • A focus on how general practice is provided to key patient groups, including vulnerable older people and mothers, babies and children.
  • Ratings of all practices to help drive improvement and support people’s choice of surgery.
  • Clear standards and guidance to underpin the five key questions we ask of services: are they safe, effective, caring, responsive and well-led?

Inspections of GP surgeries will begin after April 2014 and every GP surgery in England will have been inspected and rated by April 2016. QCS provides all the toolkits required to meet CQC quality standards.


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Alison Lowerson

GP Specialist


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