NHS GP out-of-hours services: findings from the first comprehensive inspections

We began inspecting NHS GP out-of-hours services earlier this year, using our new, more comprehensive approach to inspection. While out-of-hours services are often considered to be higher risk, we found many examples of good and outstanding care.

Between January and March 2014 we inspected 30 NHS GP out-of-hours services run by 24 registered providers. Overall, we found that the majority of services were safe, effective, caring, responsive and well-led.

This report sets out our findings. It also describes improvements that have been made since the publication of the ministerial review into NHS out-of-hours care, General Practice Out-of-Hours Services: Project to consider and assess current arrangements, in 2010.

Areas of good practice

We found that:

• Providers monitored the quality of care they provided by auditing, putting monitoring systems in place and investigating incidents. They shared lessons learned and the subsequent actions with all staff.
• There were fewer locum GPs covering shifts than we expected. Most of the GPs were sessional GPs from the local community. This meant people were receiving care from GPs who were familiar with the needs of the local population and the locally available care services.
• There were some good examples of GP out-of-hours services raising awareness in the local community and making contact with people who had poor access to primary care. This was done using social media and by working with support organisations.
• Providers had developed innovative and responsive care as a result of feedback from the local population. Examples included one service providing transport and others developing systems to predict and manage high levels of activity.

Areas for improvement

Our inspections uncovered some variation in quality and safety. We found that some providers:

• Did not have safe mechanisms for storing and checking the stocks of medicines held and recording controlled drugs. 
• Did not have appropriate recruitment processes.
• Did not have adequate systems for checking and monitoring equipment, including oxygen and emergency medicines.
• Did not inform patients how they could make complaints about the service.