Quelles solutions pour la garde en médecine générale? - KCE

KCE Reports 1771
Items
Suggestions for
improvement of affter-
hours care
Affter-Hours
Primaary
Care
Results
Secondly, aftter-hours
providers were w beginning to deliver
a satisfactory staandard
of service butt
most were not yet meeting all the nationnal
quality requiremeents,
particularly on
speed of response.
Thirdly, the aactual
cost of running after-hours a was higherr
than the money alloccated
by the Departmeent
of Health.
Fourth, commmissioners
were enteri ing into contracts with multiple providers and
the market was matturing.
In 2007, the Department of Health h commissioned the PPrimary
Care Foundation
to develop the auudit
tool used by the National Audit Office in their 2006 report TThe
Provision of OOut-of-hours
Care in England. E
This was pilooted
across a number of PCTs and has noww
been adopted by twoo
thirds of PCTs in England.
The benchmarrk
aims to assist PCTss
to improve the qualitty
of
care and to aallow
services to identify
where they might be
able to operate morre
efficiently through comparison
with other providers.
The main inddicators
are cost, prod ductivity, process, outccomes,
performance aand
patient experiencee.
‘Outcomes’ in the ccontext
of this benchmmarking
does not relatee
to
clinical outcoomes
but to whether patients
received advicce,
a home visit or atteended
a centre and wwhether
the patient waas
referred or made thheir
own decision to go
to
hospital. Clinical
coding is not generally
complete enouggh
to allow more detaailed
comparison of ouutcomes,
though the PPrimary
Care Foundattion
is looking to increease
the factors included
in the benchmark.
Department oof
Health’s 2009 project
to assess after-hours
care
In October 20009,
the Minister of State
for Health asked the National Director for Primary Care and the Chairman of Couuncil,
Royal College off
General Practitionerrs
to
review the loocal
commissioning an nd provision of after-hhours
services. This wwas
published in February
2010. The reviewwers
visited five after-hours
services and their
commissioneers
across England. The T sites visited demonstrated
a range of service provision inccluding
PCT providerss,
ambulance servicess,
social enterprises and
commercial oorganizations.
The authors sstated
that they knew from their combined eexperience
that the quuality
of after-hours seervices
in many areas was good. During theeir
visits they saw several
examples of ggood
practice but also o examples of where immprovement
was needded
from both the commmissioners
and proviiders
of services.
The report nooted
that staff who wo ork for out-of- hours services,
face a numbeer
of challenges. Theyy
treat patients who aare
not known to themm,
often without access
to
their medical records. Furthermore e, their initial contact aand
assessment of theese
patients is invariaably
on the telephone. They operate in settings
that are not like ttheir
usual surgeryy
or place of work, and d they use unfamiliar eequipment.
They may work in an area unfammiliar
to them, and with
colleagues who theyy
have never worked wwith
before. In adddition,
they may deal l with a higher proporrtion
of patients who aare
in need of urgentt
care, and are thereffore
particularly vulnerable.
These may be the
young, the elderly,
or those with ch hronic or terminal condditions.
The report mmade
24 recommendat tions. Eight of these reeferred
to commissionning
and performancee
management; ten to selection, induction aand
training of after-hoours
clinicians, and
six to the management
and operation of pperformers
lists.
The National Audit Office Report suggested
that the Deppartment
of Health shoould
encourage PCTs:
To improve ccost-effectiveness
To improve tthe
cost-effectiveness s of the service throuugh
benchmarking off
costs, improvementss
to local commissioning,
and making available
training and bbest
practice.
To perform benchmarking
For PCTs, it was suggested that th hey should benchmarkk
their costs against those
of other geograpphically
comparable PPCTs.
There was also a need to ensure thaat
all
groups withinn
the community could d access services effeectively
and that the PPCTs,
or their provideers,
met the access reequirements
set out wwithin
the national quaality
requirementss.
It noted that the man nner in which patient ffeedback
was collected,
could be improved.
To invest in ssoftware
systems
After-hours hhealth
care is delivere ed in a complex enviironment.
It needs too
co-ordinate the sharring
of information floows
not only across ggeographically
disperrsed
bases/primarry
care centres and mo obile clinicians, but alsso
between different pproviders
of health andd
social care. While thhere
are significant vaariations
in the details and
layout of diffeerent
software solution ns, successful applicattions
should to be ablee
to meet the followingg
basic requirements.
Input, transfeer
and secure storage of confidential patiennt
information. The inpput
of information will largely be conducted by simply typing the information into specified
text fields (i.ee.
call handlers or clin nicians entering patiennt
notes) but more advvanced
applications wwill
allow for daytime GGPs
to place special nnotes
about their patieents
directly onto tthe
after-hours databa ase. Transfer of patiennt
information involvess
both transfer within tthe
service, e.g. allowiing
clinicians to view pprevious
consultation and
triage notes, and transfer between services such as the national requirement tto
pass details of the cconsultation
to the pattient’s
GP by 8am the next day.
Prioritisation and ‘time stamping’
111