Despite positive feedback from patients, staffing problems and poor morale are putting services under pressure
Out of hours services provide urgent primary care when GP surgeries are closed. They form part of the wider urgent care system that includes A&E departments, NHS Direct and the emerging 111 service.
Our report shows that out-of-hours services are under significant strain. Although patients seem generally happy with the services they get, poor staff morale and difficulties in filling shifts are threatening the resilience of services in many parts of Wales, and a more sustainable approach is needed to address these challenges.
The report found that national standards on the timeliness of appointments are not being met and that patients need to be given better information about how to access services. There is also a lack of information on service quality and performance which is hampering effective management of services at the national and local level.
The planning of out of hours services typically happens in isolation from other services despite it being part of a wider urgent care system. While the new 111 telephone service will help address some integration issues, it is not going solve all the problems.
Many of the challenges identified in the report are not new, suggesting that a more sustained and vigorous approach is needed nationally and locally to put out of hours services on a more stable footing. This must include a review of the investment that is needed given that funding from Welsh Government for these services has fallen in real terms in recent years.
The report makes eight recommendations to help improve out-of-hours services, which include:
- Standardising patient information on NHS websites and GP phone lines;
- Doing more to make out-of-hours services more attractive places to work;
- Developing a national workforce plan to tackle staffing problems; and
- Doing more to spread and encourage more innovative practices.
Auditor General Huw Vaughan-Thomas added: “This report highlights the urgent need to strengthen out of hours services and address some long standing workforce challenges. Patients also need better information on how to access services. It is essential that the Welsh Government and Health Boards work together to implement my recommendations and develop sustainable improvements to these vital services”.