Main Report of the National Review of Primary Care Out of Hours Services

8 Quality and Safety

Aim

The prime objective of the Quality and Safety Task Group was to develop options for recommendations as to how the quality and safety of OOH services can be best measured, assessed and improved.

The full report of the Task Group on Quality and Safety is available on the Review website.

Recommendation 20 relates to quality, safety and good practice.

Methodology

• The shared work of the Models of Care Task Group taken into account when working up quality and safety issues
• Evidence from the rapid review of international literature at Annex F and in full on the Review website, was taken into account, as were emerging findings from the public and professional engagement programme.
• Other evidence considered included: Developing a Quality Framework for General Practice in Scotland (Joint Report by Healthcare Improvement Scotland and by RCGP Scotland, 2014); The Provision of Safe and Effective Primary Medical Services Out-of-Hours. Quality Standards, NHS Quality Improvement Scotland, 2004); Delivering Quality in Primary Care National Action Plan - implementing the Healthcare Quality Strategy for NHS Scotland, Scottish Government, 2010 and Progress Report, 2012)

The consensus was that for future for future OOH services there should be should be clear quality standards with supporting measures for improvement and monitoring of services including key measures of patient, carer and staff experience. The services will be supported to improve the care that they provide and will be an integral, visible and sustainable part of local health and care services.

Summary

Current OOH arrangements are often complicated and fragmented systems. There is an extensive evidence base highlighting the interface issues and 'pathway' risks facing patients and carers.

• A clear model of service delivery should be established, underpinned by a clear service specification

Out of hours services remain poorly understood across Scotland both by the public and by professionals often resulting in people finding it difficult to know where to go with their health and care needs. Currently OOH primary care services are poorly understood and recognised by the public, the media and politicians resulting in confusion, inappropriate contact and misplaced frustration. Specific lack of recognition of these services within Boards results in a 'Cinderella' service with underinvestment and chronic stress in the system.

• A clear understanding of understanding of the scope of OOH services is essential. NHS Boards, Health and Social Care Partnerships and IJBs should place priority on the delivery, improvement support and monitoring of quality of OOH services

The measurement of OOH service provision for improvement purposes and for monitoring of quality is patchy and poorly supported across Scotland. Recent developments, such as those by PHI in developing the OOH dataset are welcomed. The future service model and specification will require significant development of the current Healthcare Improvement Scotland (HIS) standards and indicators. This will include patient, carer and staff experience in addition to key operational measures, such as staffing of rotas.

• Healthcare Improvement Scotland should be commissioned to review the existing OOH standards and indicators in light of the new service models and to support future service specifications. These should include a specific focus on patient, carer and staff experience. They should do this in collaboration with the Care Inspectorate in relation to social care provision.

OOH services are not always considered to be an intrinsic part of the health and care system in a systematic manner. The forthcoming HIS Quality of Care Reviews will shape the future of how external scrutiny can best support the delivery of sustainable high quality care across Scotland.

• Healthcare Improvement Scotland should ensure that OOH services are incorporated as a key focus of proportionate and risk based Quality of Care reviews with related improvement support.

It is recognised that having the necessary quality improvement capacity and capability to support services to improve quality is essential. NHS Scotland is known internationally for its commitment to quality and safety and its commitment to build quality improvement capacity and capability. OOH services in Scotland have had limited improvement support to date but where that has been provided, then significant improvements in quality have been achieved.

• All Health and Social Care Partnerships should consider how their existing quality resources can support improvement in OOH services. Healthcare Improvement Scotland, in collaboration, should be commissioned to undertake a scoping exercise of improvement support requirements at local and national level in OOH.

These are translated as Recommendation 20.

Nursing staff, part of a multidisciplinary team at NHS 24, Norseman House