Problems at flagship urgent care service

A flagship urgent care service covering five primary care trusts generated dozens of complaints from patients and doctors in its first two months of operation – and call handler NHS Direct had £23,000 withheld for failing to meet its contractual requirements.

West Yorkshire Urgent Care covers more than 2m patients in Bradford, Leeds, Wakefield, Calderdale and Kirklees PCTs and is designed to meet the national policy aims of improved integration between urgent care services and improved information sharing.

NHS Direct was selected to provide call handling and triage through a single point of contact, while treatment is delivered through a separate contract with private providers Local Care Direct and Care UK.

The service went live on 1 April, and in its first two months of operation NHS Direct received 76 complaints from patients and 150 items of health professional feedback. Ten Incidents for National Review were raised and a Serious Untoward Incident relating to a patient death was reported to the coroner.

A report presented to last month’s NHS Direct board meeting says that over the first few weeks of the service patients experienced difficulty getting through on the telephone and had long waits with lower priority calls.

Treatment providers also had “end to end process issues” resulting in long waits at treatment centres and for home visits. NHS Direct had £23,000 deducted from its payments for failing to meet five of its key performance indicators.

In addition, the five commissioning PCTs raised issues about the working of a palliative care line and the transfer of data between systems.

NHS Direct said it was working with its sub-contracted GP supplier Medacs and with IT system supplier TPP to obtain appropriate reports and system changes and with treatment providers to improve home visit processes.

It said it had also appointed a new director for the centre, was analysing data to better forecast service demands and developing skills levels to improve workload management.

In a statement issued to EHI Primary Care, NHS Direct added: “As with many new services, there were initial teething problems in the first months.

“These included telephone and IT systems, plus staffing issues, which unfortunately resulted in long delays for some patients, particularly over a few weekends including Easter and a further two May Bank Holidays – traditionally a very busy time for all NHS services.

“We have been working with the commissioners of this service and the other providers to resolve these issues and our concentrated efforts have resulted in vast improvements and a reduction in waiting times and delays.

“We, as well as our commissioners, are continuing to monitor the service closely so that people get the right urgent care services they need. Due to the relentless spread of swine flu in England, we are receiving exceptionally high call volumes from patients concerned about swine flu-like symptoms.”

Dr Richard Vautrey, secretary of Leeds Local Medical Committee, said the difficulties prompted the LMC to write to NHS Leeds about its concerns.

He told EHI Primary Care: “There was a whole catalogue of problems including patients not being dealt with appropriately, not receiving call backs and being left without being visited by a GP because of communication difficulties between NHS Direct and Local Care Direct.”

Dr Vautrey said the PCTs had been closely monitoring the contract and had responded to the LMC’s concerns.

He added: “There are still some problems and concerns but nowhere near as many as there were in April. However the fundamental issue of whether it was wise to split the contract in this way remains and we are keeping a watching brief on it.”