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Report reveals out of hours health care fears

PUBLISHED: 01:01 02 October 2009 | UPDATED: 14:23 06 July 2010

There are worries about patient safety because of gaps in the monitoring of out-of-hours care, a health watchdog is warning today.

The report comes during an investigation into an East Anglian healthcare provider and was triggered by the death of a Fenland man.

There are worries about patient safety because of gaps in the monitoring of out-of-hours care, a health watchdog is warning today.

The report comes during an investigation into an East Anglian healthcare provider and was triggered by the death of a Fenland man.

The study, from the Care Quality Commission (CQC), raised fears of a “nationwide problem” with private GP companies working in England under NHS contracts.

It follows the death in February last year of David Gray, 70, from Manea in Cambridgeshire, who was accidentally killed by a German doctor working his first out-of-hours shift in Britain.

Mr Gray was given 10 times the normal dose of diamorphine by Daniel Ubani, who admitted being exhausted and only having a few hours sleep before beginning work for Ipswich-based Take Care Now (TCN).

Dr Ubani was given a nine-month suspended sentence in Germany for causing death by negligence in the UK.

TCN has contracts for out-of-hours care with five health trusts, including Cambridgeshire, Suffolk and Yarmouth and Waveney.

Cynthia Bower, CQC's chief executive, said: “Our visits to the five trusts that commission TCN's services showed they are only scratching the surface in terms of how they are routinely monitoring the quality of out-of-hours services.

“If their monitoring is not robust enough, they may not be in a position to spot early indications of potential problems or poor care.

“We believe this may point towards a national problem.”

She said more focus was needed on areas including the number of unfilled shifts, how many shifts were covered by non-local doctors, the induction and training they received; and the quality of clinical decisions.

The interim report says that TCN sometimes had difficulty filling shifts, particularly for doctors, which “puts pressure on other staff and could affect the quality of the service”.

The Department of Health is now writing to health trusts across England asking them to urgently review their monitoring arrangements for out-of-hours services.

The report also says TCN needs to finish work on its medicines policy, but says TCN has now withdrawn the 100mg ampoules of diamorphine, reducing the chance of the original mistake being repeated.

It also says that patients with a possible stroke must be immediately transferred to the 999 service.

NHS Great Yarmouth and Waveney and NHS Suffolk have both welcomed the report and say they are monitoring the quality and safety of out-of-hours care.

David Cocks, chief executive of Take Care Now, said: “We welcome the CQC's interim progress report and are continuing to work with the CQC in its ongoing investigation.'”

A final report is due to be published early in 2010.

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