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The waiting game

GP out-of-hours cooperative cuts staff and pleads with NHS to pay more

A GP out-of-hours provider, which has been forced to make redundancies after falling into financial difficulty, is asking for an urgent rise to its NHS contract values.

GP out-of-hours co-operative Shropdoc said its financial woes were a result of not being paid sufficiently by health service commissioners in the first place because of the 'competitive' tender environment in England; a delay to an expected NHS 111 contract; and workforce shortages.

Shropdoc, which provides GP out-of-hours services in Shropshire County, Telford and Wrekin, and Powys in Wales, has therefore gone to the CCGs and health board to request its contract values are urgently uplifted.

In a letter sent to GP members, and seen by Pulse, Shropdoc chair Dr Russell Muirhead said that the not-for-profit organisation is working on a financial recovery plan which has resulted in redundancies.

He said this included the ‘mutually agreed’ departure of CEO Ian Winstanley, who will not be replaced until finances are 'under tighter control'.

Shropdoc has also made redudant its director of transformation, operations director, performance manager and its programme support manager.

The letter added that the competitive tender environment in which out-of-hours providers operate has made it harder to maintain financial balance.

It said the reason for running its out-of-hours contract at a remuneration lower than the cost of delivering them was 'to ensure that when the CCG commissioners put the out-of-hours service out to tender, we were in the best position to win it against serious competition', and it had been subsidising this loss with profit from other contracts.

But the letter added that 'unfortunately, with the 111 process dragging on, the date for any tender is now approximately 2019 and we cannot sustain this position until then'. 

Dr Muirhead said: 'We have met with the commissioners to explain our position and to ask for their financial support, and to quickly renegotiate the value of the contracts for the current financial year.

‘None of the contracts delivers a surplus so it is more than just reaching a cost neutral position, there has to be some percentage of surplus to ensure the contract is sustainable. We do not know if this will be possible and to what extent they will support us.'

He also said that an initiative to address GP and clinical workforce shortages by developing a new ‘urgent care practitioner’ role had come 'at a greater cost than we planned'.

But this is now yielding some benefits and, along with the 30% of Shropdoc business from non-out-of-hours contracts, will be part of the long-term financial solution.

Dr Muirhead concluded: 'I realise that this message contains some worrying news but it is where we are as an organisation and you need to be aware of this. Every member of staff is working hard to secure our future and their efforts are very much appreciated.

'We are not out of the woods yet by any means and more work will be required over the coming weeks and months. I will keep you informed as the situation develops.'

Dr Muirhead told Pulse that Shropdoc, whch has just had 'an excellent CQC' report, had not allowed its service quality to be affected.

He said: 'The service is being sustained at its existing levels. There is no patient risk.

'This is a combination of both internal issues built up over time and negotiations with the CCGs and the health board over contract terms and conditions.'

It comes as Pulse has shown how GP out-of-hours services keep hundreds of thousands of patients out of A&E each year.

But they are on a knife-edge and services are stretched to find staff and make a profit as they are undercut by extended hours initiatives.

Readers' comments (12)

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  • Not that long ago, our Gp co-op OOH was run by a committed Gp lead plus one manager and that was it, apart from employing the drivers, a few triage nurses and yes, most of the Gp's working for the benefit of all. We've come a long way, haven't we !

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  • There is probably a manager to manage the managers and they will have meetings about meetings!
    Seriously what a farce !

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  • There is a horrible truth to the over expansion of middle management.

    I now attend meetings where I meet manager upon manager whose main job is to justify their existence and their project - regardless of how much harm or pointless it is.

    The nature, meaning and evidence of what they do means little to them as they are rarely judged on that.

    The one sympathy I have is that NHSE /Civil Service has created a culture like this and we should not be surprised at the quality or results.

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  • and I wonder how much the redundancy bill will be.If the contract was not enough they should not have bid on in the first place as another provider would not have run as a loss leader .not great buisines sense.

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  • Typo?
    Dr Muirhead told Pulse that Shropdoc... had NOW allowed its service quality to be affected.
    Presumably this should be NOT?

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  • This has been corrected

  • Typo; we have 'NOT allowed our service quality to be affected'

    Top rated CQC inspection, excellent patient quality markers, fantastic staff and we are in the proverbial.

    We are not over staffed with managers as some comments might suggest, and complex organisations need to be controlled. We operate 24/7 across 10 sites and provide at least a dozen different services - this is not old fashioned GP OOH - we are an urgent care provider. You could stick your head in the sand and just do that but with tendering being ever more difficult (last estimate £50k per contract just to bid) I would like to see your lead GP and manager getting an organisation in a winning position.
    We are in a difficult position and have come clean about it rather than just shutting up shop and letting everyone else get on with it. We are committed to our patients and local GPs who will feel the brunt if another quality provider isn't available
    Russell Muirhead
    Shropdoc Chairman

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  • Running a contract long term at a loss with cross subsidies is not in the best interests of patients as is delays the point at which a proper decision regarding funding is made.

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  • Shropdoc has been running an excellent OOH service for many years and has been blessed with the working contributions of many day-time GPs prepared to do their evening/night stints.
    If they cannot continue, God help their patients and God help the rest of the country.

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  • Vinci Ho

    I think it is easy to criticise while it is hell to run a OOH service under current circumstances. Remember who is the common enemy and thanks to Health and Social Care Bill section 75 for so called competition: basically cheaper the 'better' as far as the government is concerned. It never really wanted to learn the lesson from Capita.
    OOH is a scapegoat for Agent Hunt's scientific wisdom , better than Professor Hawking , on seven days GP opening: the impression to the public has to be there were no GP you could see after 18:30 weekdays and the whole weekend. Well , the way he starved the funding of OOH as well as doing f**k all about indemnity, will achieve this objective eventually. Hence , the hypocrisy of funding 7 day opening Vanguard sites turned into some reality out of natural selection. The truth of no new investment is simply amputating one arm and tried to make the other a bit bigger. Despicable.
    Russell , I don't know you in person but you have my support on this .

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