London

Adrian O’Dowd

The £392m (€570m; $730m) cost of providing out of hours primary care last year in England was 22% higher than anticipated by the government, a report has shown.

The cost and quality of out of hours care since GPs opted out of their 24 hour responsibility have been questioned in a report published last week by the government’s spending watchdog, the National Audit Office.

The report found shortcomings in the setting up in 2004 of new arrangements to provide out of hours care. And although no evidence was found that patients’ safety was compromised, no providers of care were currently meeting all of the 13 national quality requirements set by the government, and few were achieving ideal response times.

In its report the National Audit Office said the service was now beginning to reach a satisfactory standard and that most patients got a good service. The government, however, allocated only £322m for out of hours services in 2005-6, although the final cost was £392m.

As a response to the report the Department of Health announced various measures last week, including:

• Primary care trusts will have to come up with action plans indicating how they can improve the cost effectiveness and performance of their out of hours services;

• Trusts and providers will be invited to attend a conference later this year to share their best practices.

The report also found that savings of £134m could be made if all trusts were as good as the best performers.

Speaking at the launch of the report the director of the study, Chris Shapcott, said: "From PCTs [primary care trusts] we found performance against standards was decidedly patchy. There was also a big variation in costs that did not seem to be connected to the quality of the service."

A survey of all primary care trusts carried out for the report showed that only 15% of trusts could say they were achieving emergency face to face consultations at a centre within an hour.

Ninety per cent of GPs in England have now opted out of out of hours responsibilities, but the report says that there is a need for them to remain at the heart of the service.

The report says that was a range of pay rates for GPs for out of hours work but that the average weekday hourly evening rate was £58.36, rising to an average rate of £102.54 for bank holidays.

Hamish Meldrum, chairman of the BMA’s General Practitioners Committee, said: "The NAO [National Audit Office] finding that the costs of providing out of hours services were higher than anticipated will not be a surprise to the thousands of family doctors who, in former years, provided it on the cheap to the NHS. It is worrying that, in places, quality targets such as response times are not being met."

Edward Leigh, a Conservative MP and chairman of parliament’s Committee of Public Accounts, criticised the current services, saying: "The new way of providing out of hours medical care has so far been a costly mess that has left many sick people waiting too long for help."

The Provision of Out-of-Hours Care in England is available at www.nao.org.uk.