Dr Blogs

“Clinical review system promotes patient safety”

Serco has managed and operated the GP Out of Hours service on behalf of Cornwall & Isles of Scilly PCT for many years. The service is being carried out to the highest standards and has been repeatedly validated by a number of regulatory and external reviews. I am proud of the professional team who carry out this work.

The service we provide on behalf of the PCT in Cornwall is a GP Out of Hours Service, not an Emergency Service. However in certain cases it is necessary, after clinical assessment, to refer patients to the Emergency 999 Service.

It is worth explaining that in May last year we implemented the NHS Pathways protocol for handling incoming calls, and an unexpected consequence of this was a very significant increase in the number of patients referred to the ambulance service for emergency follow-up; we found that the introduction of the system resulted in a fourfold increase in the number of ‘999’referrals to the ambulance service and this was clearly unsustainable.

Working with the ambulance service and the local commissioners in Cornwall we decided to add a clinical review to this part of the process to ensure that patients only had ambulances requested appropriately. Therefore the decision to refer to ‘999’ does not any longer occur when the IT system decides but when our nurse or doctor who reviews the instruction decides that the patient needs an ambulance immediately.

The internal briefing note [leaked to The Guardian] that suggests that this is being done in order to somehow meet performance indicators and ‘stop the clock’ is both wholly inaccurate and misleading to people who do not work in our service. We also accept that it was written poorly. However this does not affect the performance measurement system in our service, which tracks the time starting from completion of the clinical decision until the transfer to the Ambulance Service.  This is entirely correct and appropriate. Nor do the systems in any way change the performance that is reported to the PCT and they actually ensure more accurate reporting.

All of these measures are taken in a completely open and transparent manner with the agreement and understanding of both the PCT and the South West Ambulance Trust.

We strongly refute that this is in any way inappropriate or that we in any way compromise patient safety, quite the opposite in fact. These actions ensure the best clinical care for our patients whilst ensuring that our healthcare partners’ ability to respond to the emergency healthcare needs of the community are enhanced. It is wholly our intention to continue to do what is in the best interests of the patients we care for. Patient safety is absolutely at the heart of this service.

The Guardian article alleges that the Care Quality Commission found ‘serious failings’ in the service we provide in Cornwall. This is completely untrue. The CQC (and subsequent reviews) found the service to be safe although it identified four areas where it fell short of the required standards, three categorised ‘moderate’ and one ‘minor’. These recommendations have now been fully addressed.

The article in The Guardian also carries unfounded and unsubstantiated allegations that our service was short staffed over the pre-Christmas weekend. This is not true. Indeed we have raised our clinical staffing levels and they were 10% above the baseline levels agreed with the PCT. Furthermore, in comparison to the same period last year the number of call handlers has increased by over 60%.

I want to reassure people in Cornwall that our actions provide the best clinical care for our patients. It is wholly our intention to continue to do what is in the best interests of the patients we care for. Patient safety is absolutely at the heart of this service.

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