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Modernising Primary Care
Out-of-Hours Services
Notes for PCTs, GPs and Organised Providers
in Respect of Accreditation and Reporting
June 2003
Page 1 of 20
Summary
PCTs have two key roles in delivering modernised primary care out–of-hours services:
planning an integrated service, and accrediting organised providers of the service. This
document focuses on the latter function.
All organised providers of out-of-hours services will be accredited by March 2004.
Thereafter, they will be subject to re-accreditation at least once every three years, unless
an Accrediting PCT has grounds to lead it to initiate an earlier re-accreditation.
This document sets out the arrangements for the accreditation process and outlines the
different roles and responsibilities of PCTs, organised providers of out-of-hours services
and GPs who provide such services themselves. It includes the reporting framework
which defines the manner in which all organised providers of out-of-hours services will
report to their PCT(s) on the quality of that service.
The table in Annex One on page 18 of this document summarises the different roles and
responsibilities of PCTs and organised providers of out-of-hours services.
Note
This document is a revision of advice that was published in June 2002 under the title,
The Roles and Responsibilities of Those Engaged in the Delivery of GP Out-of-Hours
Services. Notes for GPs, PCTs and Organised Providers in Respect of Reporting and
Accreditation.
This new document incorporates all that earlier advice, takes account of the changes to
the process of accreditation which were embodied in the revised GMS and PMS
regulations that now underpin the process, and explains more clearly the manner in
which organised providers of out-of-hours services should report to PCTs on the quality
of the service they provide. It does not, however, anticipate all the changes that may be
needed to reflect a new GMS contract. Explanation of the updates can be found on the
OOH website www.out-of-hours.info
Further information
For any local queries, please contact your local out-of-hours coordinator.
Page 2 of 20
Contents
Introduction 4
1 The Accreditation of Organised Providers 6
2 Withdrawing or Suspending Accreditation 14
3 Reporting 16
Annex One:
The Roles and Responsibilities of
PCTs and Organised Providers 19
Page 3 of 20
Introduction
In March 2000, the Department of Health commissioned an independent review of GP
out-of-hours services. The Report of that Review - Raising Standards for patients. New
Partnerships in Out-of-Hours Care – (http://www.out-of-hours.info/downloads/oohreview.
pdf)was published in October 2000. The government endorsed its vision of a new,
integrated out-of-hours service and accepted all twenty-two of its recommendations.
When it is fully implemented, this new model will ensure that, for the first time, the same
high quality out-of-hours service will be available to all NHS patients in England,
regardless of where they live, or the GP Practice with which they are registered.
The Review identified a number of ways in which this consistency would be secured, of
which two of the most important were:
The quality of the out-of-hours service was explicitly defined in a number of Quality
Standards, and all organised providers of out-of-hours services will report to their
PCT on their delivery of those Standards.
All organised providers of out-of-hours services will be accredited. Accreditation will
ensure that all organised providers meet a common set of minimum standards, but it
will also establish a structure in each local health community that will ensure that all
providers continue to develop and improve their services after their initial
accreditation has been secured.
While all those currently engaged in the delivery of primary care out-of-hours services
will play a critical role in securing the effective modernisation of these services, the
introduction of new regulations in November 2002 and February 2003 gives PCTs a
new, pivotal role.
PCTs are now responsible for planning and supporting the implementation of an
integrated out-of-hours service. They will co-ordinate out-of-hours’ service provision in
their areas, accredit organised providers of out-of-hours services, and approve the
transfer of some or all out-of-hours responsibilities from individual GMS GPs or PMS
pilot providers to accredited providers, and/or other GPs and/or PMS pilot providers.
Further information about the regulations can be found on the OOH website, www.out-
of-hours.info
The new regulations give GPs the opportunity to transfer responsibility for their patients
in the out-of-hours period to an accredited OOH provider (as well as to another GP).
These transfers fall short of the proposals for GP opt-out that are part of the proposed
new GMS contract and thus, if the organised provider or GP to whom out-of-hours
responsibility has been transferred ceases to be able to discharge that responsibility,
then the responsibility reverts to the transferor GP. On the other hand, it is the relevant
Page 4 of 20
PCT (not the individual GP) that will be required to make arrangements for alternative
provision to whom the GP could transfer responsibility.
As part of their co-ordinating function, therefore, PCTs need to ensure that appropriate
contingency arrangements are in place should they choose to suspend or withdraw
accreditation of an organised provider. That said, only suspension will be an immediate
act, prompted by grave concerns about patient safety; withdrawal of accreditation would
be a more managed process which would allow time for the PCT to develop alternative
provision, and for GPs the time to prepare to transfer responsibility to a successor
provider.
In addition to defining the new role of PCTs in planning and coordinating the provision of
primary care out-of-hours services, the regulations also provide a legal framework to
ensure that only organised providers that have been accredited as meeting and
maintaining specified Quality Standards will be eligible to provide primary care out-of-
hours services.
Moreover, they require all accredited organisations to report regularly to their PCT on
their performance measured against those Standards, and the remainder of this paper,
therefore, sets out the manner in which PCTs will accredit organised providers of out-of-
hours services and the form and frequency of the reports which accredited providers will
be required to submit to their PCT(s).
GPs delivering their own out-of-hours service,
or under an informal rota arrangement
GPs are of course able to continue to provide their own service out-of-hours, or indeed
to make informal rota arrangements with other GPs (inside or outside their own practice)
to deliver that service.
Where GPs do not transfer responsibility for the provision of out-of-hours services to an
organised provider, they are not required to report on the quality of that service
benchmarked against the Quality Standards. They are, however, required to deliver a
high quality service, and should therefore ensure that they maintain their normal clinical
records in respect of consultations that take place out-of-hours, enabling them to audit
the quality of those services in the same way as they audit the services they deliver in-
hours.
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Part One:
The Accreditation of
Organised Providers
The accreditation of organised providers of out-of-hours services will ensure that they
meet a common set of minimum standards, but it will also establish a structure in each
local health community that enables all providers to continue to develop and improve
their services after their initial accreditation has been secured.
In this way, accreditation will make an important contribution to the ongoing process of
service development and improvement that is at the heart of the modernisation of the
NHS. Responsibility for accrediting organised providers of out-of-hours services rests
with PCTs.
A more detailed discussion of the process, designed to support both organised providers
and those who serve as members of accrediting teams can be found in Accrediting
Providers of Out-of-Hours Care. A system for improving patient care and assuring
quality. A Handbook for Primary Care Trusts and Organised Providers of Out-of-Hours
Services (http://www.out-of-hours.info/downloads/handbook_no_links.pdf).
Copies of this Handbook have been made available to all organised providers and PCTs
The table in Annex One on page 19 of this document summarises the different roles and
responsibilities of PCTs and organised providers of out-of-hours services.
Definitions
In the discussion of accreditation that follows, three terms are used in a manner that will
not be familiar to all – these terms are defined as follows:
Organised Providers of Out-of-hours Services
An organised provider is defined as any provider except an individual GP who provides
his or her own out-of-hours service, or a group of GPs (whether in partnership or not)
who provide out-of-hours services under informal rota arrangements.
Accrediting and Assessing PCTs
In order to avoid any perceived conflict of interest, responsibility for the process of
accreditation has been separated from responsibility for accreditation itself and the terms
Accrediting PCT and Assessing PCT are used to delineate this distinction.
Thus, once an organised provider’s application for accreditation has been accepted by a
PCT, that PCT takes responsibility for the accreditation of that organised provider and
becomes (for that provider) the Accrediting PCT. The Accrediting PCT then delegates
responsibility for the process of accreditation to a PCT that is responsible for an area
outside that in which the provider delivers its services. Thus, once that second PCT has
agreed to take responsibility for the process of accreditation, it becomes (for that
provider) the Assessing PCT.
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The Accreditation of Providers
in existence at 1st December 2002
Primary Care Trusts are responsible for planning the provision of integrated primary care
out-of-hours services in their area, and for the accreditation of organised providers of
those services. From 1st December 2002, GPs are able to transfer their out-of-hours
responsibilities to an accredited organised provider of out-of-hours services, subject to
the approval of their PCT.
In practice, only organised providers that were already delivering out-of-hours services
on 1st December 2002 were eligible for this initial accreditation, and all organised
providers that submitted applications for accreditation by that date were accredited,
subject to their being visited by an Assessing PCT by March 2004.
Making an application for accreditation
Every organised provider will submit an application for accreditation. The letter of
application will identify both the geographical area in which the service is delivered, and
the range of services that is offered, and it will be accompanied by an Action Plan in
which the provider sets out the character of its existing provision and the manner in
which it will develop that provision to enable it to achieve all the Quality Standards by the
end of March 2004.
Where a provider delivers its service in the area of a single PCT, it will submit an
application to that PCT; where a provider’s services extend beyond the area of an
individual PCT, all the PCTs in whose areas the provider delivers services liaise with
each other to agree which one will act on the others’ behalf, ensuring thereby that each
different provider is only accredited once. By accepting an application for accreditation
from an organised provider, that PCT becomes (for that provider) the Accrediting PCT.
The process of accreditation
Thereafter, all the parties to this process – the Accrediting PCT, the Assessing PCT and
the organised provider – follow a clearly defined sequence, and the various steps that
make up that sequence can be defined as follows:
Step One:
All applications for accreditation from existing organised providers of out-of-hours
services that were received by 1st December 2002 were approved, and those providers
were accredited until such time as they received a full accreditation visit.
Step Two:
The Accrediting PCT delegates the process of accreditation to a PCT which is
responsible for an area outside that in which the provider will provide services. When
this second PCT accepts responsibility for the process of accreditation, it becomes (for
that provider) the Assessing PCT.
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Step Three:
Wherever an Accrediting PCT receives more than one application for accreditation, it
advises the Assessing PCT about the sequence in which accreditation visits are to be
made, drawing particular attention to any anxieties it may have about the ability of a
provider to deliver a safe service.
The Assessing PCT will take proper account of these representations but, as it may well
be fulfilling the same role for other Accrediting PCTs, it will have to determine the
sequence in which it visits providers taking into account all their views. It will ensure that
every organised provider is given at least two months notice of an accreditation visit.
Step Four:
The Assessing PCT appoints and trains a multi-professional Accreditation Team to carry
out the visit. The Team works with the provider to plan the detailed arrangements for the
visit and, once the visit has taken place, it gives the provider an initial oral report on the
outcome at the end of the day of the visit.
Step Five:
The Assessing Team completes a draft report within a month of its visit, and shares this
with the organised provider, giving the provider the opportunity to comment on the draft.
Any factual errors are corrected and the Assessing Team takes proper account of any
other comments the provider may have made in finalising its Report.
Step Six:
The final report is presented to the Accrediting PCT, including a recommendation as to
whether or not the provider should be accredited, and if so whether that accreditation be
for a period of three years or up to twelve months. Where it recommends accreditation
for up to twelve months, the Assessing PCT defines clearly what Standards remain to be
met, and what evidence the provider will have to present to the Accrediting PCT to
demonstrate that it is meeting those standards. The Accrediting PCT determines
whether or not, and for how long, the provider is accredited
Page 8 of 20
The Outcome of an Application for Accreditation
The outcome of every application for accreditation will always be one of the following:
One: The application is approved and the provider is accredited for three years
The provider will demonstrate that, at the time of the accreditation visit, it is meeting all
of the Quality Standards. The provider is accredited for three years and reports quarterly
to the PCT on its performance against the Standards.1
Two: The application is approved and the provider is accredited for up to twelve
months
The provider will demonstrate, at the time of the accreditation visit, that it is meeting
many of the Quality Standards, and that it has developed a plan to meet the outstanding
Standards.
While a good start has been made, all the Standards are not yet being met and the
provider is therefore accredited for a period of up to twelve months and reports monthly
to the PCT on its performance against the Standards.2
During that time, the provider will work with the Accrediting PCT and the assessment
team to address the concerns raised by the visit, and at any time up to and including the
end of the period for which accreditation was granted, it will submit further evidence to
the Accrediting PCT of the work that has been achieved.
The Accrediting PCT will then take whatever action is necessary to satisfy itself that the
outstanding Standards are now being met. Where it is satisfied that all the Standards are
being met, the provider will be awarded a further three years’ accreditation from the time
when it demonstrated it was meeting all the Standards; where some of the Standards
are still not being met, the Accrediting PCT may award up to a further twelve months
accreditation or, where it has serious concerns about the quality of the service that is
being provided, it may withdraw or suspend accreditation. (The grounds on which such a
decision can be taken are set out in Part Two below.)
Three: The application is not approved, the provider is not accredited and urgent
action is required
The provider fails to demonstrate an ability to meet the Quality Standards, and has not
yet have developed realistic plans to meet them in the months ahead.
The provider will not be accredited, and the Accrediting PCT will initiate an intensive
period of planning for the urgent development of the organisation, in which both the
provider and the assessment team will be involved.
An explicit, rigorous, time-limited development plan will be developed within a month,
setting out clearly the objectives that the provider will need to achieve so that it can
reach a position where it can properly bid for accreditation once more. This process of
development will be rigorously monitored by the Accrediting PCT and if at any time
(during or at the end of this process) it is convinced that the service offered by the
1
See Part Three on page 16 below for further information about the form these reports should take.
2
See Part Three on page 16 below for further information about the form these reports should take.
Page 9 of 20
provider endangers the safety of patients, it will deny the provider any further opportunity
to bid for accreditation and will at the same time withdraw or suspend accreditation.
It is important to emphasise the critical character of the role of the Accrediting PCT in
circumstances where the provider is not accredited. While the legal responsibility for
such services would revert to the transferor GP, as was made clear at the outset of this
paper, it is the Accrediting PCT (not the individual GP) that will be required to make
arrangements for alternative provision to whom the GP could transfer responsibility. As
part of their co-ordinating function, therefore, PCTs must ensure that appropriate
contingency arrangements are in place should they choose to suspend or withdraw
accreditation of an organised provider.
In practice, PCTs will rarely face a situation in which alternative provision has to be put
in place overnight. In the third outcome described above, there would be a period of
several weeks from the accreditation visit to the production of the final Report, and a
further period of time in which the Accrediting PCT reached its own conclusions in the
light of that Report.
This period would enable the Accrediting PCT(s) to both work with the provider to try to
put right the weaknesses that had been identified in the Assessing PCT’s report, while at
the same time develop an alternative form of provision which could be put in place if and
when it became clear that the provider was unable to remedy its own shortcomings.
Page 10 of 20
The Accreditation of New Providers
Making an Application for Accreditation
Primary Care Trusts are responsible for planning the provision of integrated primary care
out-of-hours services in their area, and for the accreditation of organised providers of
those services. From 1st December 2002, GPs are able to transfer their out-of-hours
responsibilities to an accredited organised provider of out-of-hours services, subject to
the approval of their PCT.
Thus, every organisation wishing to provide out-of-hours services for a local health
community will have to be accredited. Its letter of application will identify both the
geographical area in which the service is to be delivered, and the range of services that
will be offered. The letter will be accompanied by an Action Plan in which the provider
sets out the manner in which it plans to put in place a service capable of meeting the
Quality Standards. While it should aim to meet all the Standards from the outset, where
there are any weaknesses, it will need to demonstrate how it will meet all the Standards
by the end of March 2004.
Where a provider intends to deliver its service in the area of a single PCT, it will submit
an application to that PCT; where its proposed services extend beyond the area of an
individual PCT, all the PCTs in those areas in which it intends to deliver services will
liaise with each other to agree which one will act on the others’ behalf, and the
organisation will be told to which PCT it should submit its application. By accepting an
application, that PCT becomes (for that organisation) the Accrediting PCT.
The Process of Accreditation
Thereafter, all the parties to this process – the Accrediting PCT, the Assessing PCT and
the would-be organised provider – follow a clearly defined sequence, and the various
steps that make up that sequence can be defined as follows:
Step One:
The Accrediting PCT delegates the process of accreditation to a PCT which is
responsible for an area outside that in which the provider will provide services. When
this second PCT accepts responsibility for the process of accreditation, it becomes (for
that provider) the Assessing PCT.
Step Two:
The Assessing PCT appoints and trains a multi-professional Accreditation Team and its
first task is to assess the quality of the application - that assessment will include a
meeting with the applicant to help determine whether its proposals are well-founded.
Step Three:
As a result of that meeting, the Assessing PCT makes a recommendation to the
Accrediting PCT about next steps. It may recommend that the provider be accredited for
up to six months, or it may advise that further work needs to be done before the
application is resubmitted.
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Step Four:
Once accreditation for up to six months has been agreed, the provider reports monthly to
the Accrediting PCT on its performance against the Quality Standards. Assuming that
this monthly reporting reveals nothing particularly untoward, the Accrediting PCT will
then ask the Assessing PCT to carry out a full accreditation visit at the end of those six
months or sooner.
Step Five:
The Assessing Team works with the provider to plan the detailed arrangements for the
full accreditation visit and, once the visit has taken place, it gives the provider an initial
oral report on the outcome at the end of the day of the visit.
Step Six:
The Assessing Team completes a draft report within a month of its visit, and shares this
with the organised provider, giving the provider the opportunity to comment on the draft.
Any factual errors are corrected and the Assessing Team takes proper account of any
other comments the provider may have made in finalising its Report.
Step Seven:
The final report is presented to the Accrediting PCT, including a recommendation as to
whether or not the provider should be accredited, and if so whether that accreditation be
for a period of three years or up to twelve months.
Where it recommends accreditation for up to twelve months, the Assessing PCT defines
clearly what Standards remain to be met, and what evidence the provider will have to
present to the Accrediting PCT to demonstrate that it is meeting those standards. The
Accrediting PCT determines whether or not, and for how long, the provider is accredited.
The Outcome of an Application for Accreditation
The outcome of every application for accreditation will always be one of the following:
One: The application is approved and the provider is accredited for three years
The provider will demonstrate that, at the time of the accreditation visit, it is meeting all
of the Quality Standards. The provider is accredited for three years and reports quarterly
to the PCT on its performance against the Standards.3
Two: The application is approved and the provider is accredited for up to twelve
months
The provider will demonstrate, at the time of the accreditation visit, that it is meeting
many of the Quality Standards, and that it has developed a plan to meet the outstanding
Standards.
3
See Part Three on page 16 below for further information about the form these reports should take.
Page 12 of 20
While a good start has been made, all the Standards are not yet being met and the
provider is therefore accredited for a period of up to twelve months and reports monthly
to the PCT on its performance against the Standards.4
During that time, the provider will work with the Accrediting PCT and the assessment
team to address the concerns raised by the visit, and at any time up to and including the
end of the period for which accreditation was granted, it will submit further evidence to
the Accrediting PCT of the work that has been achieved.
The Accrediting PCT will then take whatever action is necessary to satisfy itself that the
outstanding Standards are now being met. Where it is satisfied that all the Standards are
being met, the provider will be awarded a further three years’ accreditation from the time
when it demonstrated it was meeting all the Standards; where some of the Standards
are still not being met, the Accrediting PCT may award up to a further twelve months
accreditation or, where it has serious concerns about the quality of the service that is
being provided, it may withdraw or suspend accreditation. (The grounds on which such a
decision can be taken are set out in Part Two below.)
Three: The application is not approved, the provider is not accredited and urgent
action is required
The provider fails to demonstrate an ability to meet the Quality Standards, and has not
yet have developed realistic plans to meet them in the months ahead. The provider will
not be accredited, and the Accrediting PCT will initiate an intensive period of planning for
the urgent development of the organisation, in which both the provider and the
assessment team will be involved. An explicit, rigorous, time-limited development plan
will be developed within a month, setting out clearly the objectives that the provider will
need to achieve so that it can reach a position where it can properly bid for accreditation
once more. This process of development will be rigorously monitored by the Accrediting
PCT and if at any time (during or at the end of this process) it is convinced that the
service offered by the provider endangers the safety of patients, it will deny the provider
any further opportunity to bid for accreditation and will at the same time withdraw or
suspend accreditation.
While it is possible that an application for accreditation from a new organisation might
result in this third outcome, in practice this would rarely happen – it is extremely unlikely
that a new organisation as weak as this would have secured agreement to embark on a
full accreditation visit at the end of the its initial six months’ accreditation.
4
See Part Three on page 16 below for further information about the form these reports should take.
Page 13 of 20
Part Two:
Withdrawing or
Suspending Accreditation
Withdrawal of Approval of an Accredited Provider
The Accrediting PCT may withdraw approval from an accredited provider if any one of
the following conditions are met:
The provider has persistently failed to meet any of the Quality Standards.
The provider has failed to fulfil its duties to comply with the requirements to
provide information, admit appropriate people to its organisation for the purpose
of assessing its provision, or report at appropriate intervals on the quality of its
service.5
The Accrediting PCT considers that it is necessary to do so for the protection of
members of the public or is otherwise necessary in the public interest.
It will notify the provider in writing of its intention to withdraw accreditation, setting out the
areas in which it is failing to meet the standards and ask it to make proposals within
twenty-eight days about the manner in which it plans to remedy those shortcomings. If
the Accrediting PCT is satisfied with these proposals, it will then give the provider six
months in which to implement them. Once it is satisfied that the shortcomings have been
remedied, it will withdraw its intention to withdraw accreditation.
If an Accrediting PCT is not satisfied with the response from the provider, and therefore
intends to proceed with withdrawing accreditation, it will give the provider notice of the
action it proposes to take and the grounds on which that action will be taken. It will give
the provider the opportunity to make written or oral representations to the PCT within the
twenty-eight day period referred to above.
Where the provider chooses not to make any representations, the Accrediting PCT will
notify the provider of its decision and the reasons for it, and will inform the provider of its
right of appeal.
Where the provider does make written or oral representations, the Accrediting PCT must
take these into account in reaching its decision and must then notify the provider of that
decision and the reasons for it, and will inform the provider of its right of appeal. In
notifying the provider of its right of appeal, the Accrediting PCT must explain the
procedure for such an appeal and explain that the provider has 28 days in which to
lodge it.
5
The precise terms of these requirements are set out in paragraph 7 of the out-of-hours regulations – The National
Health Service (Out of Hours Medical Services) and National Health Service (General Medical Services) Amendment
Regulations 2002 http://www.out-of-hours.info/downloads/Amendment_Regulations_2002.pdf
Page 14 of 20
Suspension of an Accredited Provider
Whenever the safety of patients is seriously endangered, or where it is otherwise in the
public interest, the Accrediting PCT will have the right to suspend a provider, and it will
make alternative arrangements for the provision of appropriate out-of-hours services.
Suspension of an accredited provider will mean that the provider will be treated as if it
were not an accredited provider of out-of-hours services.
The PCT may suspend an accredited provider while it decides whether or not to
withdraw approval, where it has decided to withdraw approval but before that decision
takes effect, or while any appeal is pending. If the Accrediting PCT suspends an
accredited provider while it is deciding whether or not to withdraw approval, the period of
that suspension must not exceed six months; in all other circumstances, the period of
suspension will last until the appeal has been completed.
If an Accrediting PCT is considering suspending an accredited provider it will give the
provider notice of the action it plans to take, giving the provider 24 hours notice to
present its case at an oral hearing. If such a hearing does take place, the Accrediting
PCT must take into account any representations made by the provider before it reaches
its decision. Once the Accrediting PCT has reached its decision, the PCT may suspend
the accredited provider with immediate effect and notify the provider of its decision and
the reasons for it.
Appeal
An organised provider may appeal to the Family Health Services Appeal Authority
(Special Health Authority) against an Accrediting PCT’s decision to refuse to approve an
application for accreditation, or to withdraw approval or to suspend the provider. On
appeal, the Family Health Services Appeal Authority (Special Health Authority) may
make any decision that the Accrediting PCT could have made.
Page 15 of 20
Part Three:
Reporting
Under the Accreditation Regulations, GPs who deliver their own out-of-hours service, or
who provide those services under an informal rota arrangement with other GPs, are not
required to report to the PCT on the quality of that service.
They are, however, required to deliver a high quality service, and should therefore
ensure that they maintain their normal clinical records in respect of consultations that
take place out-of-hours, enabling them to audit the quality of those services in exactly
the same way as they audit the services they deliver in-hours.
Reporting by Accredited Organised Providers
On the other hand, all accredited organised providers of out-of-hours services are
required to report regularly to the PCT(s) in whose area they deliver that service on the
manner in which they are delivering their service, measured against the benchmark of
the Quality Standards. Providers accredited for three years, are required to report
quarterly; providers accredited for up to twelve months are required to report monthly.
While accreditation explores the quality of the service delivered against the benchmark
of all the Quality Standards, it would not be appropriate to expect providers to report
regularly on every one of those Standards, and regular reports will therefore only be
required in respect of the Standards identified in the table below. Equally, whether or not
a provider is reporting monthly or quarterly, it would make little sense to require monthly
reports in respect of two of these standards (Quality Standards Five and Fourteen) and
all providers will therefore report quarterly on these two Standards.
Quality Standard Frequency
QS 5: Auditing of clinicians’ records Quarterly
QS 8: Clinical details to GP practices by 9:00 a.m. next working day Monthly
QS 12: Monitoring and auditing complaints Monthly
QS 13: Investigating and reviewing all significant events Monthly
QS 14: Monitoring patient satisfaction Quarterly
QS 25: Engaged and abandoned calls Monthly
QS 26: Time taken for initial call to be answered by a person Monthly
QS 27: Identification of immediate life threatening conditions Monthly
QS 28: Definitive telephone clinical assessment and disposal. Monthly
QS 29: Time to episode complete for face-to-face consultations Monthly
Page 16 of 20
While all the Quality Standards can be achieved by all organised providers, regular
reporting on Quality Standard 25 (engaged and abandoned calls) and Quality Standard
26 (time taken for the call to be answered by a person) may prove unduly onerous in the
absence of telephone systems that provide automated reports. But access to that kind of
telephony will be available when providers integrate with NHS Direct. Organised
providers and the PCT(s) to whom they provide their service may therefore decide that it
makes little sense to invest in that new technology in the interim period before
integration with NHS Direct, and they may therefore agree that the provider need not
report on these standards until such time as that integration has been achieved.
Where such a decision is made, however, that organised provider would only be eligible
for up to twelve months accreditation.
Where more than one organisation is involved in the delivery of an out-of-hours service,
a single, consolidated report will be presented to the PCT(s). Thus, for example, where a
provider's call handling and initial clinical assessment is handled by NHS Direct, the
NHS Direct site will report to the organised provider on that part of the service for which
it is responsible, and the organised provider will then include this data in its regular
report to the PCT.
A Reporting Template
A reporting template has been developed in the form of an Excel spreadsheet, that will
enable providers to input their data quickly and easily and, once the date has been
entered, will generate the report that they will send to the PCT(s). Where a provider is
integrated with NHS Direct, data will first be entered by NHS Direct for onward
transmission to the provider; where a provider is not integrated, it will need to enter data
against all the Quality Standards set out in the table above. The template will be made
available at: www.out-of-hours.info
Making the Reporting Meaningful
The purpose of this reporting is to enable the PCT to monitor the quality of the service
that is being provided and to provide an early indication of any problems that may be
developing in the way in which that service is being delivered. The reporting will only
fulfil this function, however, if there are regular, meaningful discussions between the
PCT and the provider.
Thus, when the first report is submitted, it would be sensible for the PCT(s) to hold an
initial face-to-face meeting with each provider to discuss that first report, explore any
issues that arise from it and agree together how they will respond to future reports. In
particular, they need to identify how frequently they will meet in future, and what form
their response to each quarterly/monthly report will take, when face-to-face meetings do
not occur.
The key issue here is for PCTs to acknowledge and respond to the considerable work
that providers will invest in producing these regular reports. PCTs should therefore both
acknowledge the work and respond appropriately to the data that is presented to them.
Where the data reveals that a high quality service is being delivered, it is just as
important that the PCT makes an appropriate response in which that quality is
acknowledged.
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Interpreting data like this can always be problematic, and it is for this reason that, for a
number of the Quality Standards, the reporting is formatted against a ‘traffic light’
standard. This ranges from red signifying real cause for concern, through amber
indicating a reasonably satisfactory position, to green where the service is essentially
acceptable. The ranges that are employed in the template have been derived from the
experience that has been gained in the exemplar, integrated sites, and are as follows:
Where the target is 90%: 80% and over is green, 75% to 79% is amber, and
under 75% is red.
Where the target is 100%: 90% and over is green, 85% to 89% is amber, and
under 85% is red.
While Accrediting PCTs will want to explore for themselves the meaning of the data that
is reported to them, presenting the data in this way should help them to reach well-
founded conclusions about the quality of the service that the organised provider is
delivering.
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Annex One:
The Role and Responsibilities
Of PCTs and Organised Providers
Roles and Responsibilities of PCTs and Organised Providers
Date PCT Organised Provider
December PCTs complete a stock take of all
2001 existing out-of-hours services.
February PCTs complete their 3 year plan for
2002 the implementation of the Out-of-
hours Review in their locality.
st
By 1 All providers submit a letter of
December application for accreditation to a PCT in
2002 the area in which they deliver services
(in which they identify both the
geographical area in which the service
will be delivered, and the range of
services that will be offered), together
with an Action Plan setting out the
manner in which they will be able to
deliver a service that meets all the
Quality Standards by March 2004.
July 2002 During this period resources from During this period resources from the
to March the national Out-of-hours national Out-of-hours Implementation
2003 Implementation Fund will be made Fund will be made available to
available to Assessing PCTs to providers to support the process of
support the process of accreditation. accreditation.
July and All providers will have access to a
August national programme of training.
2002
December All Assessing PCTs will have
2002 to access to a national programme of
January training.
2003
March All Accrediting PCTs will have
2003 access to a national programme of
training.
Page 19 of 20
Roles and Responsibilities of PCTs and Organised Providers
Date PCT Organised Provider
January All PCTs consider the applications
and that they have received and, where
February a provider offers services in more
2003 than one PCT area, informs all
those PCTs that it has received an
application. Accrediting PCTs reach
a view about the order in which
providers should be visited and,
having identified a potential
Assessing PCT, pass the
application to the Assessing PCT
with advice on the sequence in
which providers should be visited.
February Assessing PCTs consider the
2003 applications and the advice that they
have received from Accrediting
PCTs and prioritise the sequence of
visits over the period up to March
2004 in which all providers will be
visited. They inform providers of the
date on which they will be visited.
March Assessing PCTs visit all providers All providers are visited.
2003 to and make recommendations to
March Accrediting PCTs about whether or
2004 not providers should be accredited
and, if so, for how long. In the light
of that report, Accrediting PCTs
make a final decision.
After Assessing PCTs re-accredit all All accredited providers are re-
March providers at least once every three accredited at least once every three
2004 years years
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