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Independents' Day

One in ten areas left without GP out-of-hours cover

Exclusive Out-of-hours GP services are on a knife edge, with providers covering some four million patients admitting they have had overnight and weekend shifts over the past year with no GP cover, finds a Pulse investigation.

Some 104 lead out-of-hours commissioners across the UK responded to Pulse’s request under the Freedom of Information Act, with 10 saying there were occasions where patients were left with no GP available during out-of-hours shifts in 2016 due to chronic shortages of staff.

GP out-of-hours leaders say this is part of a ‘worrying trend’, with fewer clinicians available and services often relying on non-medically qualified urgent health practitioners, nurses and paramedics.

In Peterborough, there were nine shifts where 230,000 patients were left without access to an out-of-hours GP and all children under the age of four were ‘defaulted’ to A&E. Tower Hamlets, east London, had no GP available on 12 occasions last year. This meant a population of more than 250,000 was told to contact A&E or the ‘community night team’ for help.

In Doncaster, a lack of GPs meant nurses and upskilled paramedics were covering a population of 300,000 patients on three occasions, with no GP even available by phone on one occasion. Doncaster LMC medical secretary Dr Dean Eggitt said ‘the system is not safe’, adding: ‘I think 24 hours a day patients should be able to contact a senior clinician, a GP. If that is not available that is a very serious situation that must be remedied ASAP.’

National quality standards say patients should be able can access a GP face to face if ‘clinically appropriate’. In 2012, private out-of-hours provider Serco found itself in the headlines after a whistleblower revealed the company only had one GP covering a population of 500,000 people in Cornwall.

This led to a huge controversy, with the provider being removed and an investigation by Government auditors finding 60% of providers ran shifts without the optimum staffing levels. But, the Pulse investigation suggests staffing problems are worsening.

Out-of-hours providers admit that staff shortages have forced some providers to shut down provision, piling pressure on other services, such as GP practices and A&E departments. Dr Simon Abrams is a GP in Everton and chair of Urgent Health UK – the representative group for out-of-hours GP providers – said: ‘It is a worrying trend. It can be a last-minute appointment that keeps the service afloat, especially at weekends.

‘Additional funding can be required to attract takers and even then there are occasions when rotas are not full. Then, closing urgent care centres or staggering opening times is the only option. This probably impacts more on rural communities where patients are already travelling several miles to see a GP out of hours.’ He added: ‘Erosion of these services not only raises clinical risk in the community but adds to pressure on A&E.’

The CQC – which polices the safety of out-of-hours services in England – says it will ‘review’ the results of Pulse’s investigation. A spokesperson said: ‘We want to be confident these providers are monitoring their services effectively so patients receive safe care at all times.’

Readers' comments (23)

  • Vinci Ho

    (1) Starving the funding of OOH, even more radical than in hours, renders situation impossible to attract enough GPs to work (poor pay and high indemnity
    (2) Vanguard sites offered better pay pulling even more colleagues out of the system , sustaining the myth of seven days 8-8 opening with current funding level and obscuring the importance of continuity( thanks to Pulse to publish the article supporting the value of continuity a couple of days ago). Shame to those protagonists.
    (3) And would you really think all these are accidental and incidental? Where is the responsibility of the government(s)? Shame on Cameron and May.

    OOH is part of us , destroy OOH , destroy us


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  • Private contractors bidding war to get contract at lowest price. then reduce gp pay per hr. Here in Yorkshire directly through provider is 65/hr. Far less than daytime. medicolegal Risk is 100%more. Who wants to do ooh.. Pay properly then we will do it. There are plenty of gps who are willing to do ooh but stopped due to poor pay and medicolegal risks.

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  • OOH work should really be double daytime rates. This is what happens in many other professions in the private sector. I have never done OOH work because the pay is not worth the medico-legal risk and stress involved.

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  • Neil Bhatia

    OOH is unattractive at current pay rates and with the indemnity overhead.
    Increasingly, the pool of GPs available and willing to do this will simply worsen as CCGs push for routine extended access surgeries (or even urgent care sessions competing with OOH) outside of core GMS hours.

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  • OOH -tax free -job done .

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  • The CQC do not give the public the realty of how dire the situation is - all part of keeping cost low and pretending to the public they have adequate Gp cover over night. Maybe the CQC should
    Do more unaccounced visits to OOH providers for the real
    Picture of the NHS OOH

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  • I've been working for the local out of hours service for 12 years. It's in a dire state currently. I often turn up to my night shift to start picking up the pieces from day shifts where the staffing levels were scary - one GP doing the job of three, sometimes no GPs at all for entire shifts. Absolutely shocking.

    It's not been unusual to see patients who have waited over twelve hours for visits, including palliative patients and verifying deaths (even at home addresses).

    It is a quiet crisis. As ever, the hospitals get all the press coverage.

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  • In our day jobs we are doing the job of three GPs

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  • David Banner

    The vanity project of extended hours for routine appointments evenings and weekends will soon mop up the few remaining GPs who were bravely providing OOH care, leading finally to its total collapse. Expect May/Hunt to bully us into taking back OOH responsibility, which will trigger a stampede of GPs to the exit.

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