What We Measure

Reports for each PCT contract with an out of hours provider include:

• Case volume: Measured in cases per hour

• Cost: Measured as cost per case and cost per head of registered population.  We also look at cost compared to ‘population density’ to look at the impact of a rural or urban seting.

• Productivity:Measured in cases per clinician hour at the busy time at a weekend

• Clinical governance: Because of doubts about the comparability of answers using the self-assessment process we recommend providers and PCTs jointly review what processes are appropriate locally.

• Outcomes: looking at the levels of advice, base attendance and home visits as well as at referrals or self-referral to hospital. 

• Performance: Against the standards for time to definitive clinical assessment and time to the face to face consultation

• Patient experience: measured annually through questionnaires sent to recent users of all out of hours services

• It is now clear that providers have been recording and reporting on data in different ways and the benchmark is encouraging greater consistency so that like for like comparisons can be made in all areas.

• There is now widespread acceptance of our approach which is seen as far more rigorous than previous exercises by the National Audit Office and the Healthcare Commission. It also offers a clear basis for making credible comparisons across organisations and, as the benchmark progresses, over time.

• Over 100 PCTs have now bought into this service, nearly all of them for three years, exceeding DH targets.  As membership increases, the strength and credibility of the benchmark is enhanced.

We have emphasised that on many of these performance measures there is no simple way of identifying what is good or bad.  Rather than taking one measure in isolation, we encourage providers and commissioners to take all of the measures together as a rounded picture of overall performance.  Crucially, it enables services to focus on areas of comparative weakness and explore further, often looking at the even wider variation of the performance of hundreds of individual doctors, nurses and other clinicians,  that underpins organisational variation.