OOH Benchmark Commentary
NHS Berkshire and WestCall NHS, Berkshire Healthcare NHS Foundation Trust
Provider of Urgent and Unscheduled Out-of-Hours Primary Care in the Berkshire West area
Introduction and Local Circumstances
In Berkshire West we are committed to working together with the Provider of the Service, WestCall,
Berkshire Healthcare NHS Foundation Trust, to ensure that a high quality primary care service is
delivered during the Out-of-Hours period. The objective is to meet the need of patients requiring
urgent care, provide them with agreed clinical management and treatment whilst emphasising the
value and importance of the continuity of care provided by their own GP. The benchmark of out of
hours services has provided a useful check on this process and has highlighted some of the things
that we do well and provided information in case there are some areas where we can do even
Out of hours Primary Care provision has a critical role in supporting the PCT’s strategic direction to
shift care outside an acute hospital setting where this better meets the need of patients; to move
care to more local services and make best use of available resources.
NHS Berkshire aims to ensure that people in Berkshire will receive access to the right high quality
care, in the right setting at the right time in the event of an emergency or the need for urgent
medical attention. People will access a greater proportion of care outside hospital and in closer to
home settings therefore reducing unnecessary admissions to secondary care.
In the Berkshire West locality the Out-of-Hours Service faces the challenge of very high call
volumes combined with mixture of geographical areas, population densities and demographics.
The Newbury area is predominantly rural; Reading is a large urban area with a relatively young
population and the Wokingham area has a mixed population density with a high elderly population.
Berkshire West is designated as one of the least deprived PCT areas however conversely the
demand on the out-of-hours service is very high, according to the benchmark, with over 200 cases
per 1000 population. The reasons for this are not easily identifiable however it may be a
combination of a diverse population with high expectations of local services and a well-known,
responsive out of hours service.
Commentary on the Main Findings
We are pleased to see that the Service performs well against the National Quality Requirements
particularly in times to definitive clinical assessment and face-to-face consultations where it is in the
top quartile even when taking into account cases where the delay is attributable to the patient.
WestCall works continually to provide a consistently responsive service with a high level of patient
safety. We are particularly pleased that the Service is ranked amongst the top 5 out of hours
services where the patients’ perception of ease of getting through to the Service corresponds with a
high percentage of calls answered within 60 seconds. The GP patient survey reported higher than
average levels of satisfaction by patients both with the time taken to treat their condition and with
the treatment that was provided.
The cost of the Service when calculated per head is slightly towards the upper end of the median
which reflects the high workload however the number of cases treated has resulted in a low cost per
case and demonstrates the efficiency with which the Service copes with high levels of demand.
The survey specifically asked two questions that were raised following the various reports into Take
Care Now. These were in regard to the regularity with which the performance of the Service is
reviewed by the PCT Board and the level of reporting by the out of hours service including the
number of unfilled hours for medical staff.
The performance of the out of hours service is reviewed quarterly at PCT Board level where
consideration is given not only to performance against National Quality Requirements but to clinical
audit processes and reports for medical and call handling staff. The Service has never had any
vacant planned duty sessions and has had no occasion to make any report on unfilled shifts to the
Board. There are robust recruitment, training and induction processes for new medical staff in
place within the Service. The Service and the PCT have co-operated to ensure that the Service has
a system of continual clinical audit of medical, clinical and call handling staff. A selection of duty
sessions are audited against a consistent scoring system, any areas of weakness that may be
identified are discussed at interview and the member of staff is mentored and supported to ensure
that performance improves.
WestCall has continued to be an integral part of the local health community in Berkshire West and
has formed close links and co-operative working with the local acute trust and A&E Department;
local GPs; the Minor Injuries Unit; community nursing; intermediate and palliative care teams. The
Service also has direct access to the national spine and, as part of Berkshire Healthcare Foundation
Trust is working with the PCT to promote ease of access and simple navigation of local community
health services during the out of hours period.
Actions and Future Plans
NHS Berkshire West as commissioners of the Service and WestCall, BHFT, as the provider are not
complacent and intend to work together in co-operation with local GP commissioning consortia to
ensure that the Service continues to perform well. The introduction of Berkshire NHS 111 by April
2013 will be an opportunity to ensure smooth transition to a new system whilst maintaining high
standards of service delivery and patient safety.