Unscheduled care for providers
Unscheduled care providers deliver patient care outside normal GP surgery opening times, which amounts to 70% of the week. Unscheduled care providers are usually consulted by patients without access to their records and must base their assessment of the patient solely on the information provided by the patient themselves. This factsheet gives information about some of the risks that unscheduled care providers face and some of the issues they should be aware of.
OOH care
Implementing risk management strategies is paramount for providing and maintaining a quality and safe service to patients
The general medical services (GMS) contract, implemented in April 2004, gave GPs the opportunity to opt out of providing unscheduled patient care. Health Boards are responsible for commissioning and delivering unscheduled care services.
Implementing risk management strategies (identifying and assessing the risks within the organisation and ways of delivering services) is paramount for providing and maintaining a quality and safe service to patients.
Providers of unscheduled care must comply with National Quality Requirements and national standards – for example, Standards for Health Services in Wales.
Improving safety in unscheduled care providers
Risk management strategies are paramount to providing and maintaining a quality and safe service to patients. MPS advises unscheduled care providers to undertake a comprehensive and facilitated risk assessment, in partnership with all service providers, to identify unscheduled care service risks.
Unscheduled care providers must also ensure that all frontline staff are competent in language skills, communication and local policies and allied health and social services.
There should be specific policies in place for high-risk patient groups such as children, patients with mental health problems and patients receiving palliative care
Unscheduled care providers must ensure that they have appropriate medical indemnity arrangements in place to cover potential liabilities arising from work undertaken by the organisation and its employees.
There should be specific policies in place for high-risk patient groups such as children, patients with mental health problems and patients receiving palliative care. It is also important to have a robust mechanism in place for identifying patients who contact the unscheduled care provider on more than one occasion over the same problem.
Repeat contacts should trigger re-assessment of whether a face-to-face meeting is necessary to be able to exercise sound judgment about what is in the patient’s interests. There is the risk of misplaced reassurance when a patient has already been reviewed by one or more colleagues during a care episode. This is particularly relevant for those patients who have communication and/or learning difficulties.
Details of all unscheduled care consultations should be sent to the practice where the patient is registered by 8am the following morning. If this is not done, the patient’s GP will be unaware of the unscheduled care consultations and this may affect future care.
Telephone systems
Unscheduled care providers may need to provide additional training for doctors before they take on telephone triage or use any decision support software, which doctors may not be familiar with. There should be a policy on action to take if a doctor is unable to contact a patient who has requested assistance.