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GPs go forth

GPs cancel leave and work overtime as practices are 'flooded' by flu

'Horrendously pressured' GP practices are going the extra mile in an attempt to care for a barrage of patients hit by winter illnesses, whilst being discouraged to pass them over to emergency services, Pulse has learned.

GP leaders told Pulse they were cancelling leave or working late into the evening to deal with an influx of patients stricken by flu.

Patients are 'waiting in reception for hours' in some areas and some practices have run out of locums as they try to provide more in-hours clinics to cope with demand.

This is occuring as GPs are encouraged to take on extra risk to keep patients out of hospital and after NHS England recommended hospitals cancel non-urgent appointments and operations until the end of the month.

In one area, GPs were told to ask patients to make their own way to hospital if they needed assessment or admission and not call an ambulance.

Dr Kieran Sharrock, medical director of Lincolnshire LMC, told Pulse that practices in his area have been ‘flooded with winter related illnesses and are finding it hard to cope’.

He said: ‘Reports of patients waiting in reception for hours are not unusual. I heard from some practices that reception staff and GPs have not been leaving their surgeries for up to two hours after official closing.’

He added that local out-of-hours services regularly have ‘over 100 calls waiting to be triaged, and not nearly enough appointments at the Primary Care Centres’.

Dr Eamonn Jessup, North Wales LMC chair, said that hospitals in the area were 'creaking at the seams' amid 'a spike in genuine flu', while patients were struggling with 'three-week waits' for GP appointments.

He told Pulse: 'Primary care in North Wales is just horrendously pressurised at the minute. GP, A&E and out of hours are all part of one system and all three are under enormous pressure. It is really very busy.'

Dr Jessup also raised concern about the safety of patients amid pressure on GPs not to transfer them to hospital.

He said: 'There are patients who you would normally like to go into hospital who you are trying to keep at home and taking more of a risk than you normally would. It’s a tragedy.

'GPs are doing their best but they haven’t got three sets of arms. And GPs are very worried about patient safety and putting themselves in a professionally compromising situation - that is a significant concern for GPs these days. Every GP does their best but sometimes that’s not good enough.'

BMA GP Committee chair Dr Richard Vautrey, a GP in Leeds, told Pulse he and colleagues 'just received a message highlighting the pressures the local ambulance service are under and encouraging patients to make their own way to hospital where possible'.

He said this came as 'the local out-of-hours service has been very busy and the hospitals have been at capacity for the last few weeks, not just the last few days'.

Dr Vautrey added: 'This is all a direct result of a decade of underfunding which has not matched the increase in the population or the growing number of frail elderly patients.'

The message from the Yorkshire Ambulance Service NHS Trust, seen by Pulse, said it was currently facing 'extreme pressure' because of ‘high volumes of patients requiring emergency ambulances and the additional time it is taking to transfer patients on arrival at hospital due to pressure in emergency departments’.

The message added: ‘Wherever possible, if hospital assessment or admission is essential and the patient is able to make their own arrangements to get to hospital, we would ask that you advise them to do so rather than requesting ambulance transport.’

According to the trust's website, this included responding to over 4,100 emergency incidents on 25 and 26 December alone, including 781 life-threatening emergencies – an increase of around 200 on last year.

Pulse has already reported that out-of-hours services in Northern Ireland are buckling under the strain of winter pressures, including one trust reporting GP out-of-hours call back waiting times of 34 hours. Northern Ireland GPC chair Dr Tom Black called for 400 more GPs to cope with the strain and added that GPs had worked hard to keep in-hours services going as much as possible over the Christmas holidays.

He said: ‘In my own practice we cancelled any leave except for bank holidays and that way we managed it. There is winter pressure funding for GPs to run additional clinics but once we got to Christmas there were no locums available.

'None of us worked in out of hours as we felt it was more important to keep in hours services going. GPs in the day time see 20 patients for every one patient seen in out of hours.

'What gets forgotten is that 95% of patients get seen during the day we really have to focus the resource and workload. We have four doctors, two full time, and two part time - although we need five - and we all worked full time, that’s how we dealt with it.’

Craig McLean, deputy director of operations at out-of-hours provider Lincolnshire Community Health Services NHS Trust, said it saw 'an increase of more than 200% in demand at peak times' during the holiday period.

But he said: 'Throughout this time, 97% of patients received were seen within four hours. We have recorded a 16% increase in demand against the same period last year.

'Our teams have worked tirelessly to undertake detailed planning to prepare for predicted peak periods, including over-establishing shifts.'

Elsewhere, Dr Nigel Watson, chief executive of Wessex LMCs, told Pulse that local out-of-hours services have said ‘the Christmas period was the busiest on record’.

He added: ‘Many practices do what they do best – work flexibly and all work longer to meet the demand.’

Dr Peter Horvath-Howard, vice chair of GPC Wales, said: 'Out of hours is stretched beyond belief. The GPC has concern Wales wide about the integrity of out of hours.' 

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Readers' comments (21)

  • I suggest referring everyone to hospital who needs to go to hospital.

    If you don't, and they die, and the person who dies has a living advocate to raise the profile of the case, you risk facing a civil law suit, loss of the right to work through the GMC and a potential criminal manslaughter charge. Even if you win all 3 of those the press will have condemned you already.

    NO ONE will thank you for covering up a failing system.

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  • anyone too ill to stay at home? send them to hospital. hospital won't accept? tell patient to call 999. you will burn for negligence if you don't over the three years of the civil criminal and professional inquiries that follow your act of solidarity with the hospital sector colleagues who vanish like mist. as for overtime and cancelling leave - FFS you must be joking.

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  • I fully agree. Your indemnity is too important these days. Send everything in just as you would any other time. It is not worth the risk.

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  • Completely agree. Work absolutely in the best interests of patients. Whilst I hugely sympathise with our hospital colleagues if a patient died because they weren’t admitted and should have been you’d be hung out to dry. And I think we’re all sick of being told the crisis is in A and E- I suspect acute medicine, district nursing, general practice, DMOP, radiology,OT, physio and a LONG list of other specialities are equally stretched.

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  • Agree. Hospital inability to cope is not our problem. I will not change my referral decision based on external factors.

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  • Why do so many people need to be seen with flu? Is there a high rate of complications with this strain - surely most fit adults just need to stay in bed and away from gp receptions?

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  • Are we holding these GPs who cancelled their leave as some sort of heroes? Silly silly people

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  • I agree with Jezza.

    The entire situation is created by Whitehall gradually but continuously ignoring the advice from GPs about the problems of an underfunded primary care service. Funding has not increased and workload has. That means that GPs have to use secondary care in situations where a lot of GP work could keep someone out of hospital. When I get a call from a patient who has fallen over at 6pm and cannot get up, I have a choice of visiting them, picking them up, checking them over and ensuring they are safe - which might take an hour, or telling them to call an ambulance. 5 years ago I chose the first option. Tomorrow if it happens I will have a number of patients still in the waiting room so will choose option 2.

    Now every person who tries to 'protect' secondary care by working ridiculous hours is doing themselves and their families a disservice and just extending how long it will take before people wake up and realise that funding primary care is the solution.

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  • If in doubt admit. Have all our colleagues gone mad. They will be waiting a long time for their medals for 'heroic ' services rendered.

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  • Jesus complex crucifying yourself and your family life on behalf on the religion that is the NHS for little benefit for you your family or in the long term the patients.FFS.

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