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Poor providers of urgent primary care are not making the best use of nurses, health watchdog finds

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Low performing providers of urgent primary care are not using nurses in the most effective way, the healthcare watchdog for England says.

In its latest report on urgent primary care services, the Care Quality Commission found that at services deemed inadequate or requiring improvement, staff, including nurses, were often being asked to fill in gaps in the GP rota and work outside their competencies.

The document – The State of Care in Urgent Primary Care Services – says that professionals who did not have the competencies, skills or knowledge to fill in these gaps were not being given adequate supervision or support.

But the CQC said that the majority of primary care services were providing good care despite workforce and commissioning pressures.

The majority of walk-in and urgent care centres, NHS 111 and GP out of hours services in England were rated good or outstanding.

Inspectors looked at 147 providers of urgent care. They rated 118 good and 10 outstanding, while 19 were found to be underperforming – 16 required improvement and three were rated inadequate.

The report also found that services requiring improvement or deemed inadequate were sometimes being prevented from innovating by commissioners.

The CQC gave the example of providers being prevented from sending a nurse rather than a doctor to verify deaths because of contractual restrictions imposed by commissioners.

The report said that effective urgent primary care benefitted not only patients but the wider healthcare system by easing pressure on other services. The CQC argued that “the value of its impact was greater than the cost of service provision – but this is not always considered in complex commissioning decisions”.

Other problems highlighted by urgent primary care providers included staffing pressures, compounded by the reality of unsocial working hours and a high reliance on self-employed clinicians. In addition, many providers said they had difficulties in accessing people’s medical records.

Voluntary sector groups raised concerns to the CQC of a lack of public information about which services to contact and when. In particular guidance was needed to overcome people’s historic reliance on accident and emergency, the CQC said.

Professor Steve Field, Chief Inspector of General Practice at the Care Quality Commission, said: “It is encouraging that the majority of care is rated good or outstanding and important that commissioners and other services recognise the value that urgent care offers as part of integrated care for people in a local area. As CQC’s interim work reviewing local systems has shown, the relationship and interaction between services is vital to better patient experience and outcomes. 

However, he added: “There is more to be done to make sure complex commissioning arrangements and gaps in public information do not undermine care or undervalue these essential services.”

The NHS Confederation, which represents the majority of NHS providers and commissioners, said the report showed the need for investment in new models of care in the community.

“This report recognises that most urgent primary care services provide good care but that some areas could improve,” said Niall Dickson, chief executive of the confederation. “We believe we have not invested at the speed or with the urgency required in new models of care in the community.”

Dickson said it was “shocking” that over the past eight years spending on primary care in England had fallen in real terms. “Indeed from the mid-90s the number of hospital doctors has increased by 72%, whereas in the same period the number of GPs fell by 5%.”

He added: “Unless we increase investment and reform the services that surround our hospitals, the whole system will fail.”

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