GP out-of-hours care in Cardiff and Vale 'diabolical', watchdog claims

Delays in GP out-of-hours service responses puts more pressure on A&E claims patient watchdog

GP out-of-hours health care in Cardiff and the Vale of Glamorgan is "diabolical" and should be overhauled, a patient watchdog has said.

People are waiting too long to be assessed over the phone and to be seen by medical staff, according to the local community health council.

It said the result was more people turning up at A&E "inappropriately".

Cardiff and Vale University Health Board (UHB) said it was improving the service in response to growing demand.

Targets missed

Patients who do not need urgent care but cannot wait until their GP surgery opens are advised to use the out-of-hours care service.

After ringing a central number, a clinician calls back and advises whether the patient needs a home visit by a doctor or should go to one of three centres - at the University Hospital of Wales (UHW), Cardiff Royal Infirmary or Barry Hospital in the Vale of Glamorgan - following an assessment, or triage, over the phone.

But the community health council's chief officer Stephen Allen said even the basics were not happening.

"We have concerns about the time people are taking to have calls triaged and the time it is taking for patients who are being triaged to be seen by a healthcare professional," he said.

"We have raised it with the health board on numerous occasions and unfortunately they are consistently missing those all important targets for the last eighteen months."

The Cardiff and Vale board serves a population of 472,000 and receives around 9,000 to 11,000 calls to the out-of-hours service each month.

Its telephone triage targets say all urgent cases should be assessed within 30 minutes and all routine calls within two hours.

In October 2013 one routine call took more than 16 hours to assess, while there were examples of urgent calls taking five hours to assess in October 2013 and February 2014.

However, the service did meet its target of identifying all immediate life-threatening conditions within five minutes every month since May 2013.

Mr Allen said his watchdog believed the cover provided to be inadequate, particularly after 01:00 when only one doctor is available for all calls with a nurse in support.

"If you have one doctor covering the centre - which is the Heath hospital [UHW] at that time of night - and on the road, well he can't do both."

He added: "It's diabolical. There's no other word for it and really I feel sorry for the patients who are picking up the phone tonight who may need to access the out-of-hours service.

"That is why we strongly believe that people are pitching up at the A&E department inappropriately."

'Delivered improvements'

Sue Morgan, head of operations and delivery for Cardiff and Vale UHB's primary, community and intermediate care clinical board, said a full service review and improvements were under way.

She said there had been "a significant increase in demand" for the GP out-of-hours service over the last 18 months, with a 31% year-on-year increase over the winter. She added that the board a looking at ways of improving the service to meet the increased demand.

Ms Morgan said: "The GP out-of-hours service like many frontline unscheduled care services is constantly working to meet the growing demand.

"We would apologise to anyone who is unhappy with the service or care that they have experienced but would also remind people to use the appropriate support for their needs; to contact 999 in emergency situations and to make use of their local pharmacy, GP or NHS Direct if unsure which service is best placed to help them."

The Welsh government said revised standards and national monitoring of GP out-of-hours services across Wales would be published shortly following a review by Dr Chris Jones, chairman of Cwm Taf health board.

A spokesperson said: "Benchmarking of services will be undertaken to ensure equity of provision for patients across Wales."