National Audit Office Press Releases
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Out-of-hours GP services in England
Full report: Out-of-hours GP services in England
Although some parts of the NHS in England are achieving value for money for their spending on out-of-hours GP services, this is not the case across the board, according to the National Audit Office.
Out-of-hours GPs provide urgent primary care when GP surgeries are typically closed. They form part of the urgent care system, along with other services including NHS 111 and A&E departments.
Today’s report finds that the number of cases handled by out-of-hours GP services has fallen significantly, from an estimated 8.6 million in 2007-08 to 5.8 million in 2013-14. This is partly because of the introduction of the NHS 111 telephone service. The NAO estimates that out-of-hours GP services also cost less now, in real terms, than they did in 2005-06, but NHS 111 makes cost comparisons difficult.
Most patients are positive about their experience of out-of-hours GP services. The GP Patient Survey in July 2014 reported that 66 per cent of people rated their overall experience as very good or fairly good, although there was significant geographical variation. The NAO also found that out-of-hours service providers are generally responsive, measured against the timeframes specified by the Department of Health.
Since April 2013 most out-of-hours GP services have been commissioned by clinical commissioning groups. Most of these groups are managing their contracts for out-of-hours GP services actively, monitoring and challenging the performance of providers.
But NHS England commissions about 10 per cent of services directly – from GP practices that have retained responsibility for providing out-of-hours care. NHS England does very little to manage and oversee these services. This means that people whose GPs continue to provide out-of-hours care can have less assurance that they will receive an acceptable service.
Overall, NHS England did little during 2013-14 to assure itself of the quality and value for money of out-of-hours GP services. Although the body told its 27 local area teams to seek assurance about these services in March 2013, it did not give guidance about how to do this until a year later. The arrangements that have now been put in place are unlikely to provide meaningful assurance, as clinical commissioning groups are required to answer just a few yes-no questions.
A survey commissioned by the NAO found that around a quarter of people had not heard of out-of-hours GP services. Awareness among certain groups, including younger people and people from black and minority ethnic communities, was lower than among others. People who had not heard of out-of-hours GP services were more likely to go to A&E departments or call 999 if they or their family felt unwell during the night or at the weekend. NHS England has a clear vision to integrate urgent and emergency care services in future, but has not finalised its implementation plans.
“Although some clinical commissioning groups are achieving value for money, this is not the case for the commissioning of all out-of-hours GP services. NHS England has much to do to help secure improvements throughout the system and to increase its oversight of the out-of-hours GP services it commissions directly. It should also work to raise public awareness of how and when patients should contact out-of-hours GP services, and needs to be prepared to take the lead in integrating these services effectively with other parts of the urgent care system.”
Amyas Morse, head of the National Audit Office, 11 July 2014
Notes for Editors
5.8 million
Estimated cases handled by out-of-hours GP services, 2013-14
800,000
Estimated home visits by out-of-hours GPs, 2013-14
£400 million
Estimated cost of out-of-hours GP services, 2013-14
£7.50
Estimated average cost per person of out-of-hours GP services, 2013-14
10 per cent
Estimated proportion of GP practices that have retained responsibility for out-of-hours care
66 per cent
Of people rated their experience of out-of-hours GP services as 'very good' or 'fairly good', reported in July 2014
85 per cent
Of providers started at least 90 per cent of face-to-face consultations with urgently ill patients within two hours, September and December 2013
87 per cent
Of clinical commissioning groups that manage an out-of-hours contract receive performance information at least monthly
26 per cent
Of people have not heard of out-of-hours GP services, according to a nationally representative survey in May 2014
1. Press notices and reports are available from the date of publication on the NAO website, which is at www.nao.org.uk. Hard copies can be obtained by using the relevant links on our website.
2. The National Audit Office scrutinises public spending for Parliament and is independent of government. The Comptroller and Auditor General (C&AG), Amyas Morse, is an Officer of the House of Commons and leads the NAO, which employs some 820 employees. The C&AG certifies the accounts of all government departments and many other public sector bodies. He has statutory authority to examine and report to Parliament on whether departments and the bodies they fund have used their resources efficiently, effectively, and with economy. Our studies evaluate the value for money of public spending, nationally and locally. Our recommendations and reports on good practice help government improve public services, and our work led to audited savings of £1.1 billion in 2013.
