Quelles solutions pour la garde en médecine générale? - KCE

106
Items
Affter-Hours
Primaary
Care
Since the beeginning
of 2005, the e health authorities haave
exercised responnsibility
for the designn,
recruitment and opperation
of after-hourrs
services for which the
framework iss
laid down by the recent
General Medical
Services (GMS) conntract.
This contract ggives
GPs the opporttunity
for the first timee
of contracting out their
responsibilityy
for after-hours servic ce delivery for patientss
on their list. In areas where doctors choosee
this option, the regioonal
health authorities purchase the servicees
of
doctors emplloyed
seasonally or on o a short/medium term
basis to cover aftter-hours
care for a ggiven
budget, but theyy
are also looking intto
the ways in which the
provision of ccare
might develop in the longer term. As a result, rather than being
requested to providde
a service, GPs aree
given an incentive to remain in the after-hoours
service schemme
as contractors to the
health authority.
The Carson sstandards
were review wed and formed the foundation
for the nationnal
quality requiremennts
(NQRs), which camme
into effect in Januaary
2005.
From that timme
all after-hours ser rvices had to be delivvered
to these requirements
as a contracttual
obligation, regarddless
of where patiennts
lived. As part of tthis,
providers hadd
to regularly report and a exchange informaation,
undertake regular
audits, operate an appropriate complainnts
system, and demoonstrate
the availability
of
capacity to mmeet
demand at all tim mes. Providers also haad
to ensure that an aappropriately
qualified member of staff wass
available when needded,
that they met targgets
relating to thee
initial phone call, initial
consultation and fface-
to-face consultattion,
and that provision
was made for thosee
who did not speak EEnglish.
The requiremeents
are further deescribed
under the sec ction indicators/qualityy
requirements.
In 2008:
The Health and
Social Care Act 20 008 introduced a new, single registration sysstem
that applies to booth
health and adult social
care. The new syystem
will make sure that
people can eexpect
services to me eet new essential stanndards
of quality and safety that respect thheir
dignity and protecct
their rights. The neew
system is focusedd
on
outcomes, raather
than systems and d processes, and placces
the views and expeeriences
of people whho
use services at its ccentre.
In 2010:
Since 1 April 2010, all NHS care providers
are required by law to be registereed
with CQC and mustt
show that they are mmeeting
the essential sstandards.
All adult soocial
care and indeependent
healthcare providers p must be registered
under the 20088
Act (which replaces the Care Standards AAct
2000).
Four Models usedd
with Co-operatives
set up by profession nals: Usually doctors, who tender for contraacts
to provide after-hours
care for a set peeriod
for a PCT. Somee
of these are designaated
GPs:
as ‘social entterprises’.
These organizations
run as businness
models, but either
invest all profits backk
in services or have eexpressed
social aimss.
PCT-organizeed
providers: through other NHS providers, e.g. ambulance trustss.
Private commmercial
companies: tha at tender for contracts to provide after-hourss
care for a set period for a PCT.
A mixture of tthe
above.
Financer and
Where GPs oopted
out to their Primary
Care Trust (PCT) and under the Generaal
Medical Services Contract,
they gave up an average of 6,000 ppounds
per annum.
financing system On average 772
and 115 euros per hour to take on locumm
(replacement) duties.
Full-time afteer-hours
service GPs, usually working withinn
a co-operative, are paid
between €118,0000
and €147,000, as aggainst
€100,000 on avverage
for the other GPPs).
Some organizzations
offer bonus pa ayment schemes for some
bank holiday weeekends
and when therre
is a high demand (ee.g.
swine flu).
Characteristics off
Initiator:
model most frequently
GPs.
used (GP co-
Number of GPs
taking part in optin ng out after-hours caree:
operatives)
90%.
Number of coo-operatives
152.
Population:
No informatioon
available.
Distance:
No informatioon
available.
Indication:
Intended for uurgent
help requests that t cannot wait until the
next day.
Availability:
After-hours reefers
to the periods wh hen GP surgeries are generally closed. Theese
are from 6.30pm too
8.00am on weekdayys
and all day at weekends
and bank holidays.
Results
KCE Reportss
171