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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)

  • If I was that GP I would have refused to work on the grounds of being unsafe. All patients should have been directed to A+E.

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  • It's not forced to - it chooses to. If it paid an appropriate rate for high risk work it would have no problems with staffing. This is an example of market forces at work.

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  • I wonder how much they paid him?

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  • 18 Feb 2016 2:40pm

    i know - greedy GP - if he really cared and 'loves' the NHS he should do it for free.

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  • IC24 is unable to recruit GPs because of not addressing concerns before they took over from the ambulance service. Their answer to raised concerns and indemnity costs was this: if you don't like it we will hire agency GPs. Huh.
    They also have a massive inability to reflect and correct. " skill mix" my behind.

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  • This comment has been moderated.

  • This is how we had European Doctors flying into the UK to cover shifts, even though then had no language skills and were unfamiliar with Drug names.

    Indemnity costs for doing a reasonably regular shift is untenable and its no wonder why shifts cannot be filled.

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  • Several counties have just one GP overnight with nurse practitioners to see many patients(loosely used term)as some of them are actually not primary care or emergency Nurses practitioners but specialist nurses in hospital such as asthma,urology or cardiac failure nurse who moonlight in OOH.
    Such NP`s do home visits as well. Although they could be experts in a small area of their expertise they are not trained in all areas or have experience in broad range of specialities they tend be overcautious and refer more or miss some important problems which present as trivial symptoms.
    Not unexpected with the funding cuts and NHSE want GP`s/Federations to take back OOH for free!!!
    Some of these have more than 1 million patients each. Also some OOH have some GP`s in a their primary base triaging and a skeletal staff elsewhere but CAN BE listed in the bid for each CCG as "triaging clinicians", the joy being the same GP who being counted as one triaging clinician for each CCG contract but each CCG unaware that the the same person is being counted as a clinician in each of the CCG covered!!
    The catch phrase used by OOH now is "service delivery within the financial envelope".

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  • Wow! Jeremy Hunt's prediction that we will not need doctors to diagnose illnesses in the future has come to pass. It is a miracle!

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  • Chris Kenyon

    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.....

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  • Is this another area where the government is looking to follow the US model?
    Abolish home visits - and any OOH cover?

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