Quelles solutions pour la garde en médecine générale? - KCE

110
Items
individual woorking
within the servic ce. This audit must bee
led by a clinician with
suitable experience in providing AH care and, where appropriaate,
results will be shaared
with the multi-disciplinary
team tha at delivers the service.
Providers must coopperate
fully with PCTs in ensuring that thesee
audits include clinical
consultations for those
patients whosse
episode of care inv volved more than one provider organization. .
Providers muust
regularly audit a random r sample of pattients’
experiences of f the service (for exammple
1% per quarter) and appropriate actioon
must be taken on the
results of those
audits. Regular rep ports of these audits mmust
be made availablle
to the contracting PPCT.
Providers must coooperate
fully with PCCTs
in ensuring that these
audits includee
the experiences of patients p whose episode
of care involved more
than one provider oorganization.
Providers muust
operate a complaints
procedure that is consistent with the pprinciples
of the NHS complaints proceduree.
They will report anoonymised
details of eeach
complaint, annd
the manner in wh hich it has been dealt
with, to the contraccting
PCT. All complaaints
must be auditedd
in relation to individdual
staff so that, whhere
necessary, appropriate
action can be taken.
Providers muust
demonstrate their ability to match their capacity to meet preddictable
fluctuations inn
demand for their contracted
service, espeecially
at periods of peak
demand, succh
as Saturday and Sunday mornings, annd
the third day of a Bank Holiday weekkend.
They must alsoo
have robust contingency
policies for those
circumstancees
in which they may be b unable to meet uneexpected
demand.
Providers muust
ensure that patient ts are treated by the cclinician
best equippedd
to meet their needs, (especially at periodss
of peak demand such
as Saturday mornings),
in the most aappropriate
location. Where W it is clinically apppropriate,
patients mmust
be able to have a face-to-face consultaation
with a GP, includding
where necessaryy,
at
the patient's place of residence. Fa ace-to-face consultatioons:
whether in a cenntre
or in the patient’ss
place of residence, mmust
be started within the following timescaales,
after the definnitive
clinical assessm ment has been compleeted.
Patients unable tto
communicate effecttively
in English will bee
provided with an intterpretation
service within
15 minutes of
initial contact. Provid ders must also make aappropriate
provision ffor
patients with impairred
hearing or impaireed
sight.
Accreditation:
Affter-Hours
Primaary
Care
Once an orgaanization
is accredited d, the Health Authorityy
is responsible for ennsuring
that the performance
of the organizaation
met the Quality Standards. All Standaards
have equal sttatus
and any assessm ment of whether or noot
they are being met mmust
take account of tthe
provider's performaance
across the full raange.
In the first instannce,
audit data woould
be reported quarterly
to the PCT
with an annual
report by the PCT to the Health Authority,
but PCTs will have a duty to report to the
Health Authority if, aat
any time, they havee
serious concerns abbout
the ability of aan
individual provider to meet those Standaards.
Once such a report has been mad de, if the Health Authoority
is satisfied that the
provider is in- deed failing to meet the Sttandards,
a remedial nnotice
is issued, requiring
the provider to meet the Standard ds within a maximum of six months. If, at the end of six monthhs,
the Standards aree
still not being met, aaccreditation
will thenn
be
withdrawn annd
the provider will no longer be able to provvide
services for GMSS
contractors or PMS ssites.
In such circumsstances,
responsibility for the provision of those
services will revert to the GPs who o had delegated their after-hours responsibbilities
to that providerr
although, in almost aall
circumstances, the Health Authority and the
PCT/G, workking
with those GPs, would w have made suree
that appropriate alterrnative
arrangements for the proper provisioon
of after-hours services
would have been put
in place.
Individual GPPs
who provide their own o after-hours servicces
(either on their owwn
or through a practtice
rota), or who beloong
to a small, informmal
GP rota, and who are
working withiin
GMS rules, will be required to meet exaactly
the same Qualityy
Standards, for it is oonly
in this way that reeal
equity of provisionn
for patients will everr
be
achieved. They
will report their performance
directly to tthe
Health Authority. TThe
PMS contracts off
those GPs who also deliver their out-of- hhours
services in this wway
will be amendded
so that they too in nclude the requiremennt
to meet and report oon
the Quality Standarrds.
In either case, Heealth
Authorities are chharged
with responsibbility
for taking apppropriate
action where ever an individual GP ffails
to meet the Standdards.
Who does the
Department oof
Health and the Care e Quality Commission.
measurement
Local health aauthorities
(responsible
for accreditation and
monitoring of qualityy
of after-hours servicees).
Outcomes (evidennce):
National Audit
Office Report
In May 2006 the National Audit Off fice published a reportt
examining the provission
of after-hours caree
in England. It had four
key findings.
The report found
some shortcomings
in the initial commiissioning
process becaause
PCTs lacked expperience,
time and reliable
management daata.
Results
KCE Reportss
171