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Out-of-hours provider forced to rely on one GP for 850,000 patients overnight

An out-of-hours provider in Norfolk has admitted GP shortages have forced it to run services with only one GP for 850,000 patients on at least one overnight shift.

It comes as the CQC confirmed it was planning to carry out an inspection of the service – run by Integrated Care 24 (IC24) – at the request of former care minister and local MP Norman Lamb.

The problems have emerged as the local CCG stepped in to investigate complaints about the quality of the service provided during the month of January.

NHS Norwich CCG said it carried out an ‘unannounced visit’ to IC24 after reports of concerns, including that a ‘depleted GP workforce’ was impacting on the quality and clinical safety of the service and that ‘assessors were made aware of situations when only one or two GPs were available for Norfolk and Wisbech’.

IC24 has since issued a statement confirming that during the period of alleged failings in January, the service ran with just one GP was on call overnight on a Sunday, while only two GPs were available on another two Sunday night shifts.

However the provider told Pulse this was down to shortages of GPs and high indemnity costs, and that the service continued to be GP-led with the support of highly experienced clinicians.

In a statement, IC24 said: ‘Because of historic[al] GP recruitment issues locally, CCGs in Norfolk and Wisbech have been forward thinking in commissioning a service with a broader skill mix of qualified clinicians which means that while the service is GP-led there are many other prescribing and non-prescribing clinicians who are delivering patient care.’

NHS Norwich CCG said it was ‘assured’ IC24 was looking to improve the service and acknowledged the difficulty the provider faced hiring GPs.

Chief Nurse and Director of Quality at NHS Norwich CCG, Sheila Glenn, said: ‘The CCG is assured that IC24 is in the process of making the required improvements. It recognises these will take time, particularly when GP recruitment is such a difficulty.’

However, the CQC is also planning to inspect the service after receiving a letter from Mr Lamb. According to local newspaper reports, the MP was told by a whistleblower within the organisation.

A spokesperson for Mr Lamb confirmed to Pulse that he ‘wrote to the CQC to raise concerns after being contacted regarding out-of-hours GP services in Norfolk and Wisbech’ and that ‘he felt that the issue was serious enough to warrant an investigation’.

CQC deputy chief inspector Ruth Rankine said: ‘We plan to carry out an inspection of this service to investigate concerns, including those raised by Norman Lamb MP. We’ve also sought assurances from senior managers about how they are ensuring patients are safe during the interim.

‘It is critical that patients who need a GP out of hours can access care that is safe, effective, caring, responsive and well led.’

Continuing struggles with filling GP out-of-hours shifts

The Family Doctor Association (FDA) had warned of an impending ‘meltdown’ in GP out of hours due to indemnity costs.

But the recruitment crisis in GP out of hours is not a new issue - a 2014 National Audit Office report showed 60% of providers were struggling with unfilled shifts, not just because of rising costs of indemnity cover but because GPs were already so ‘punch drunk’ exhausted from working their regular shifts to be able to commit to out of hours.

However, a CQC investigation into OOH providers in 2014 found they had exceeded expectations and there was ’lots of good practice’.



Readers' comments (16)

  • Beggars are not choosers. No staff as indemnity is too high-the reason being too much litigation and payments made from GP pockets by way of indemnity. OOH providers have limited money as they are paid by contracts.
    The winner- Mr Hunt- he could not foresee it while everybody could. I definitely think the patients should vote for him.

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  • in response to ..Chris Kenyon | GP Partner18 Feb 2016 10:27pm

    I used to do overnight shifts, I know what this feels like, but it was never as bad as this. One day I might need these people myself, god forbid....

    Just go to to AE. You might see me there too.

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  • There is incompetence and complicity in former PCTs and now CCGs for appalling OOH staffing and service.

    The contracts negotiated are poor and the the providers fall to meet the targets but the concerns are swept under the carpet as 'Officially' they may appear to meet their Key performance indicators.

    For example if all patients need to be contacted within 4 hrs, and service switches back at 8am - almost no-one contacting service after 4.01am will be contacted as they will go back to being GP practices problem before 4hr window closes.

    Staffing in Surrey has been at similar levels with 1-2 GPs overnight for several hundred thousand patients, but now hidden behind endless levels of 'skill mix' triage before even any hope of reaching a GP, and when busy call out ambulances or advise to go to A&E instead to control workload.

    It costs money to run services and JH is trying to screw down workforce costs before his US private healthcare mates jump on board and suck the life out of the NHS - then award him a place on their boards for several million a year for doing F all.

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  • From my area I know that if you pay reasonable rates the clinicians will come. I see many docs locally resigning partnerships for OOH work. There is little paperwork, single issue consults, and you can do one thing at a time which is unheard of in my practice.

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  • There is a certain cost to train a doctor. A doctor needs a certain level of pay. You need a certain sum to run a reasonable service.
    If you do not pay reasonable and fair sums, market forces will stop doctors working.
    Add litigation, GMC, CQC to the mix and ergo = there wont be doctors.
    But JH is right we probably do not need doctors, especially GPs.
    We GPs see 90% of contacts and JH states we can do without GPs.
    There is logic for you. Britain may soon find out for real if we need doctors or noctors.
    All JH needs to do is impose a few more Contracts.

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  • And what if CQC decides to shut the OOH provider down? That'll REALLY help the situation, won't it?

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