Summary
As pressures on GP out-of-hours (OOH) services increase across the NHS, providers are seeking cost-effective and scalable solutions that maintain care quality while improving efficiency.
In response, the Innovation Agency, part of the AHSN Network for the North West Coast, commissioned the Health Economics Unit (HEU) to undertake an evaluation of Doc Abode, a digital workforce deployment platform.
Doc Abode enables OOH providers to dynamically match urgent care shifts with local GPs based on availability, location, language, and clinical expertise.
The evaluation aimed to explore the return on investment (ROI) of integrating Doc Abode into existing OOH models. Using real-world service data from FCMS – a leading provider of OOH services – we developed an economic model to assess the financial impact.
The model demonstrated that implementing Doc Abode could reduce the overall cost of OOH service provision by approximately £1.4 million annually for a population of one million, translating to a return of £2.73 for every £1 spent. These savings were largely driven by reduced reliance on agency and contracted GPs, with Doc Abode enabling a flexible, pay-per-contact approach to filling unstaffed shifts.
The challenge
OOH services face a persistent challenge: how to ensure GP availability during evenings, weekends, and holidays. Traditional rota-based systems frequently result in unfilled shifts, leading to higher agency costs or longer wait times for patients. For providers like FCMS, this not only impacted operational budgets but also had downstream effects on patient experience and potentially on emergency care utilisation.
Integrated Care Systems (ICSs) must find ways to optimise staffing while addressing growing demand. Doc Abode offers a novel, digitally enabled alternative – but decision-makers needed evidence to support its economic value.
Our approach
To assess the cost-effectiveness of Doc Abode, the HEU developed an interactive ROI tool, populated with real-world data from FCMS. The model compares the cost of delivering GP OOH services with and without Doc Abode for a population of one million. Key elements included:
- Number and type of patient contacts (home visits, telephone calls)
- Use of employed, contracted, and agency GPs
- Shift fill rates and service configuration
- Direct costs of using Doc Abode (annual licence and per-consultation fees)
The model was designed to be flexible, allowing other ICSs or providers to input their own data and explore localised ROI scenarios.
The results
In the base case scenario, integrating Doc Abode reduced the total cost of OOH service delivery from £8.94 million to £7.54 million annually. Although the Doc Abode service itself incurred a cost of £512,921, this investment led to an overall net saving of nearly £1.4 million. This gave an ROI of 2.73.
These cost reductions primarily stemmed from fewer agency staff and reduced need for contracted GPs, replaced by item-of-service payments to GPs via Doc Abode.
Learning and next steps
The analysis confirmed that Doc Abode has the potential to deliver substantial cash-releasing savings while maintaining service capacity. FCMS validated that the cost reductions observed in the model aligned closely with their real-world experience.
While the ROI tool focuses on direct costs, further research could examine patient experience, service responsiveness, and potential reductions in A&E attendances due to improved access to urgent GP care.
For commissioners, the ROI tool provides a valuable framework to assess whether a similar model could deliver savings in their own OOH configurations. By allowing flexible user inputs, the tool supports strategic planning and local decision-making.