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GPs go forth

30% increase in out-of-hours GPs needed, say urgent care leaders

The number of GPs needed to staff out-of-hours rotas needs to increase by roughly one-third if GPs are to help meet the increasing demands in urgent care, out-of-hours leads have said.

Dr Simon Abrams, chair of Urgent Health UK and a GP in Liverpool, told delegates at a King’s Fund Urgent and Emergency Care conference in London today there are significant issues, around indemnity costs and targeted inspections from tax collectors over GPs’ employment status – as revealed by Pulse – which are making it even harder to recruit.

He told delegates a major priority had to be 'breaking down obstacles' to recruitment and retention, such as 'high indemnity costs, risk related to HMRC investigations of employment status, and low morale which is leading to higher levels of early retirement'.

Dr Abrams added: ‘We estimate that we will need a further 30% more GPs, than are currently available.’

He also stressed that co-locating GPs alongside A&E departments and developing multidisciplinary teams to work with GPs delivering care out of hours in primary care ‘hubs’ were also important.

But he said that the Government's seven-day routine GP care initiatives exacerbated workforce pressures on out of hours by pricing providers out of the market.

He told Pulse: 'The problem is the destabilisation we have when pilot projects... are offering £100 an hour or more per shift.

‘We need to get the balance right of supply and demand - it’s the GPs working who hold the market because there’s too few.’

This also extends to payments for working in CCGs or other roles, which will reduce the total availability of GP clinical time, he added.

NHS England clinical adviser Dr Cliff Mann - who is the previous president of the Royal College of Emergency Medicine - told delegates at the event that co-location of out-of-hours GP services and A&E would address many of these problems.

Dr Mann told delegates that hospitals employing GPs directly removed the burden of indemnity from GPs and was an ‘easy win’.

Readers' comments (12)

  • That's a surprise. A secondary care doctor wanting GPs to be employed by Trusts so that they can take over OOHs.

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  • Why would one do it for less than £100 per hour, by the time Insurance, tax effectively at 60% for those between 100K and 120K, and then superannuation leaves less than £30 in the pocket per hour. But it is also the high level of litigation and complaints that stops many Drs doing it. Finally after 5 days of 12-14 hour days why would I want to do more and risk my physical and mental health and that of my family without considerable financial compensation? I was paid £70/hour OOH 10 years ago with quarter of the insurance costs and less tax and other deductions, so remuneration should frankly be at £150 to £200 per hour which is the locum rate for senior hospital Drs with no indemnity costs.

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  • Emergency Medicine needs to expand its remit but not with OOH. It needs to be more like Oz.

    The biggest issue for me is the Primary Care complaints system. It's not the indemnity, it's the process and the overall risk to my licence.

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  • Everywhere they talk about bringing GPs in to work here, expanding GP provision there, transferring secondary care to the community, and rolling out routine appointments to the weekend and late evening. At the same time the proportion of NHS funding to these very 'expanding areas' (save a few politically driven vanity projects) has been reduced. Where exactly do they think these GPs are going to come from? No one can afford the indemnity to work in OOH. A large proportion of the work force if due to retire over the coming years with insufficient numbers to replace them. The health minister takes pleasure in denigrating the entire medical profession at any opportunity. What a load of total crap.

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  • 'there needs to be a balance between supply and demand'

    The demand is insatiable - and there is no supply

    We should all be charging £200 / hour like solicitors etc (and secondary care consultants!)

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  • Out of hours pay rates in my area have not changed in 12 years still around £70 per hour. You pay more from a plumber out of hours. Yet indemnity fees and MDO board member salaries rise way above inflation. Pay peanuts, get monkeys.

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  • GP Registrar 8.43.
    I fully agree with you. It is the complaints culture of primary care, the lack of respect from the public, the attitude and risks of going for home visits alone night time.
    OOH in A/E is the worst scenario, it has failed in numerous areas where it has been set up.
    The public expectations have been raised sky high, making OOH not an urgent contact but a continuation of GP service with patients coming and asking for referrals.

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  • I would love to do more urgent care, I was working 2-3 days per month on top of my full time salaried job.
    Money was ok initially and indemnity covered by the local trust. Then I entered the 'lucky' 100-120k group and my effective rate of tax has gone up to 62% including national insurance. To be blunt there is no f**cking way that I'm working 1/3 take home rate.

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  • Took Early Retirement

    My solicitor charges £300 IN HOURS. And she is worth it.

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  • Just decided to cut back from ooh shifts- a five hour shift in the evening did not cover a one hour plumbers bill on a Sunday . Not worth the stress and subsequent fatigue from working all day in practice and then doing ooh.
    Think the whole issue of pay and indemnity needs to be sorted or the crisis will only get worse.

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