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GP commissioners provide £400k cash injection to help out-of-hours provider fill shifts

Exclusive GP commissioners have agreed to bail out an out-of-hours provider after it suffered a recruitment crisis that meant 15% of its shifts were unfilled during the first half of 2013/14.

Somerset CCG approved a cash injection of £470,000 to South West Ambulance Service NHS Foundation Trust (SWAST) after the provider said it struggled to pay wages that would attract GPs to take on the shifts.

The additional funding will go towards increasing the rates of pay for out-of-hours GPs in the region, as well as improving the use of triage, emergency nurse practitioners and the way calls are dispatched for home visits.

The commissioners said they had raised the issue of staffing with their out-of-hours provider ‘on a number of occasions since April 2013’.

Further information released to Pulse under the Freedom of Information Act revealed that SWAST managed to fill only 85% of its shifts in the first two quarters of 2013/14.

This follows major concerns about out-of-hours recruitment across the UK. Local GP leaders welcomed the move, and suggested other areas may be looking to take the CCG’s lead.

A paper discussed at the CCG’s board meeting on 22 January said: ‘The primary care out-of-hours service has been experiencing difficulties in the recruitment of GPs.

‘This has resulted in unfilled shifts, which in turn has had an impact on performance and equity of access. South Western Ambulance Service NHS Foundation Trust maintained that one of the key contributory factors to recruitment was that the Somerset GP pay rates have fallen out of line with other health communities.’

The trust submitted a business case seeking new funding to increase wages, and the £470,000 injection was approved at the meeting.

A spokesman for the CCG said: ‘For some time now SWAST has had difficulty securing sufficient Somerset GPs to fill out-of-hours service cover. Gaps in GP cover has, on occasion, meant shifts have had to be filled by agency doctors.

‘One of the factors identified as contributing to the problem has been the differential rates of pay for GPs providing out-of-hours cover compared with neighbouring counties. At the January 2014 meeting of Somerset CCG’s governing body it agreed to raise the rates of out-of-hours pay to bring it into line with our neighbouring areas.’

Somerset LMC welcomed the move, and said the county had very specific problems with recruiting GPs.

Dr Harry Yoxall, medical secretary at Somerset LMC, said Somerset was a ‘relatively small, fairly scattered rural county’, without a large concentration of sessional doctors or locums and there was also a problem with younger doctors leaving the county after their training.

He said: ‘There has been some discrepancy between the rates that the out-of-hours service here pays and the ones that are paid by adjacent organisations, such as Brisdoc. SWAST wanted to offer broadly similar rates so they are competing in the same market.’

Other areas may be looking to take Somerset’s lead, he added. He said: ‘There will be other places like us, rural counties without university towns and a pool of doctors, so I cannot believe we are unique. Speaking to other LMC colleagues, filling OOH sessions is quite difficult.’

Dr Andy Smith, a GP and medical director for SWAST, said: ‘In Somerset, over time, pay rates for similar work, such as GPs working in emergency departments, have risen, meaning that the out-of-hours rates are no longer competitive. As a result, to ensure that we remain an attractive place to work, we require an uplift in these rates.

‘We are very pleased that this has been approved and expect this to improve our ability to recruit to our service.’

Readers' comments (22)

  • Vinci Ho

    OOH service has been underfunded, full stop.
    It is not rocket science you need to reward colleagues optimally for working these anti-social hours . The rate per hour must be even worse than average presumably ?
    One can argue if we have a 'modified' and properly funded OOH service , there is no need for this eye pleasing politically driven debate about 7 days opening .....

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  • The power of market forces,and supply verses demand starting to exert themselves.Forces which we will all feel in the next decade as the supply of GPs will likely decline.There will be good and bad effects.Interesting(but not good)times.

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  • SWAST were awarded this contract based primarily on the costs documented in it's tender. They have done this while pricing their GPs less than neighbouring areas and are now surprised that they cannot attract GPs.

    Other providers who priced their staff appropriately would have bid higher and lost out to SWAST. Is it not inherently unfair on those losing bids.

    The whole point of a commercial organisation taking over the running of this type of service is they profit from it if everything goes as planned.... and pay the difference financially if things do not work out well. The alternative is to end the contract early and pay the penalty which would also have been in the bid ding document.

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  • Vinci Ho

    Then the argument is the commissioners had the responsibility to work out an estimated pricing(with breakdowns )which ensured the feasibility and viability of the service before considering any AQP. And the commissioners should never live under the threat and terror of NHSE and blindly went for 'cheaper the better'.....

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  • I note this is a NHS trust, so therefore more immune to competition law. Should this have been a social enterprise or a private company, they would have had a contract termination notice and put out to tender. Rewarding failure.

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  • why are the commissioners paying? surely the contractor has to pay the market rate and accept the consequences

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  • So the commissioners carry the can for cost quality and anything else along the way??? Surely if you can't provide a service you agreed to deliver at an agreed cost you the provider must take responsibility be it financial, loss of contract not the purchaser paying more.. That would seem to be an odd market to me.

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  • This is the rule out Private providers - make hay and eat it while the sun shines, when the costs are higher, the profit margins remain, as they just cut the service provision back, no matter what they promised when they won the tender - Commercial pressures is their get out of jail free card.

    They then turn a running service into a pig's ear and then decide to walk away from the contract - not giving any care or thought to the patients involved.

    On complaining to commissioners - just told they can do that as they are a private company, and there is an exit clause they have chosen to exercise.

    GP practices run and take the pay cuts, MPIG adjustments, QOF changes, cuts to enhanced services, practice list cleansing exercises, locum superannuation costs, lack of maternity cover payments for staff, and despite all that the take the hits and run their practices, and put their patients first.

    No wonder the government spends all their time feeding the media with stories of fat cat GPs to allow private providers in.

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  • So if I tender for a DES then struggle to get the staff to undetake it my CCG will give me extra money? This is a total p*ss take.

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  • Parity with plumbers hourly rate at a weekend . Fill shifts no bother .

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