Medicine shortages, manipulated targets and patients doing nurses' jobs: ITV's Exposure at an NHS Out of Hours clinic

Mark Austin

Former ITV News presenter

A month-long undercover investigation of our NHS Out of Hours service for ITV’s Exposure programme has revealed shocking failures in patient care.

The programme focuses on a privately run Urgent Care Centre in Ealing, West London and finds doctors not fully trained for the job, targets being manipulated and even patients being asked to do the jobs of nurses.

In the programme we send two reporters undercover, one who takes a work experience placement and one as a patient. What they discover is shocking.

For a start the reporter who did work experience was not asked for any ID, her references were not checked and nor were any background checks carried out.

At one point a staff member tells her that doctors are doing work on x-rays they are not trained to do, and she is also told that patient assessments have been changed in order that the Centre can meet financial targets.

Other failings uncovered at the Centre run by Care UK include understaffing - with clinics sometimes dealing with almost 50% more patients than they can properly manage - and medicine cabinets being low on stock.

In the programme we also speak to a GP who used to work at the Centre. Dr Mike Smith tells us he would never work there again. He says: "I feel we have reached a point where the disregard for basic processes that ensure patient care has led me to believe we are going to reach a point where significant harm will come to a patient."

I also speak to experts in Out of Hours care. One, Dr Peter Holden, the British Medical Association's special advisor on Urgent and Unscheduled Care, is particularly worried about what he called the "clinical overload" apparent at the centre.

"It is always a risk for serious mistakes […] if I worked a shift in this place it would only be a single shift and I’d be telling them what I thought and I’d be blowing whistles."

Private involvement in NHS out of hours services has grown rapidly since 2004, when the Labour government allowed GPs to opt out of out of hours care. The coalition government further opened up the services to private involvement. In the past year, £6 billion worth of NHS contracts have gone to private companies.

A medicine cabinet is shown low on stocks at the centre. Credit: Exposure/ITV

Following our findings about patient assessments and targets, Care UK told us: "GPs review the patient list throughout the day to ensure they are always seen in order of clinical priority. There is an escalation process to manage any emerging clinical risks."

On a staff member's claim that some doctors were doing work they were not trained to do, the company said: "Doctors are issued with detailed guidelines on using x-rays and we require our doctors to attend an external radiology course. We also undertake our own internal education.

X-ray orders within the service are checked by a separate radiology department within 24 hours. Audits indicate that no fractures have been missed."

On understaffing, Care UK says: "A request was made for additional funding to meet winter pressures but the constraints faced by the NHS in the area have made it impossible for the requests to be met. The centre has a robust and effective escalation process to manage unexpected peaks in demand."

And on the shortage of medicines, they say: "Stocks are monitored closely and additional supplies of necessary medications are available to senior staff."

Exposure: NHS Out of Hours Undercover will air at 10.40pm on ITV on Wednesday.