GP out-of-hours deal criticised

Out-of-hours doctors cover in Cardiff is supplied by a private firm

A health board did not properly look at risks when it awarded a GP out-of-hours contract, says a financial watchdog.

Auditor General for Wales Jeremy Colman said Cardiff Local Health Board (LHB) should have made more inquiries into the firm involved, Clinical Solutions.

Cardiff LHB and the company, now called Healthcare Services 24, welcomed the finding that the tender process had been "robust and fair."

The board said there had been a major improvement in performance recently.

Conservatives urged the Welsh Assembly Government to review the contracts system of all 22 Welsh LHBs and Plaid Cymru called on Health Minister Brian Gibbons to apologise to patients.

Paying twice for something is not a good use of public money, particularly when it turns out that what is being paid for doesn't exist at all Auditor General Jeremy Colman

Clinical Solutions UK/Europe Ltd was selected in May 2004 provide to night-time GP cover in the city from 30 September that year.

In March 2005 the company was acquired by Serco plc and renamed Healthcare Services 24.

The company took over from a co-operative of GPs who had provided the service for the previous eight years.

But the health watchdog Cardiff Community Health Council (CHC) and GPs' leaders expressed worries about the way the service was being run.

In March 2005, the CHC held a spot-check over the Easter bank holiday and found that patients who rang the firm's call centre for advice often faced a long wait for someone to ring back.

'Potentially misleading'

It also said there was a lack of knowledge about where people had to go to pick up prescriptions outside normal surgery hours.

Mr Colman said the selection process run by Cardiff LHB had been "robust" but checks into the company's financial background and clinical experience did not go deep enough.

The report also found a briefing for LHBs board members was "potentially misleading" because it "exaggerated the international experience of the successful bidder".

It is completely unacceptable that there were failures to properly manage the contract for such a critical service Plaid Cymru AM Rhodri Glyn Thomas

Mr Colman also criticised the LHB's decision to award Clinical Solutions £59,000 extra to hire additional nurses at weekends - work which the company was contractually obliged to provide from its own budget.

The report recommended LHBs review their procedures to ensure their full board approves or ratifies the award of contracts that "carry significant risks".

'Lessons to learn'

Mr Colman said the company was "paid extra on the basis of a claim that they were having to deal with unprecedented levels of demand and we found that this simply was not true."

"When we examined the figures we found that the supposed extra demand just wasn't there.

"Paying twice for something is not a good use of public money, particularly when it turns out that what is being paid for doesn't exist at all."

The report also recommended the Welsh Assembly Government advise LHBs on the checks they should make to ensure firms have the financial capacity and experience to deliver medical services.

Plaid Cymru health spokesman Rhodri Glyn Thomas AM said: "It is completely unacceptable that there were failures to properly manage the contract for such a critical service."

The Welsh Assembly Government said it accepted the recommendations and would take time to consider them.

It said the system for out-of-hours services was fairly new, but LHBs were getting more used to it.

Cardiff LHB and Healthcare Services 24 welcomed the conclusion that, overall, the tendering process, the first of its type in Wales, had been "robust and fair".

Dr Robert Jones, chair of Cardiff LHB, said the context and timing of the decision had to be appreciated, when public safety was an issue.

"Last October the perception was right across the country that demand for out of hours services was going through the roof. At that time it was decided that we put public safety first."

Dr Jones said the company was "working to contract and the service has made steady improvements."

He accepted there were "lessons to learn" over awarding contracts and assessing claims for additional funding and an action plan would go to the LHB's public board meeting in September.