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Out-of-hours shifts being run with no GPs due to recruitment crisis

A GP out-of-hours provider covering 300,000 patients has been running overnight shifts without any GPs on the rota.

NHS Doncaster CCG said its out-of-hours provider FCMS had struggled with a shortage of GPs, forcing it to staff shifts with only nurses and other healthcare professionals.

It said that the patient service had always been 'guaranteed' and the other healthcare professionals had 'access to GP advice' - but the LMC has said simply meant GPs at home picking up calls from other healthcare staff who were running the service on their own.

The provider also admitted that in two instances over the past four weeks, there was no GP on-call whatsoever.

GP leaders in the area said it was an 'appalling situation' that was a 'patient-safety critical incident'.

This is the latest in a series of incidents involving out-of-hours providers struggling due to a lack of GPs willing to work the extra shifts for a variety of reasons, including rising indemnity costs and increased in-hours pressures.

FCMS - which runs the out-of-hours cover out of its urgent care centre co-located with the A&E department at Doncaster Royal Infirmary - said it had run a number of shifts led by 'a combination of experienced nurses and emergency care practitioners, with an ability to prescribe, but without a physical GP presence'.

It said that during the past four weeks, 'one overnight shift of eight hours was not covered and three hours of another shift were not covered' by a GP at all, while 'other shifts have been covered through an on-call GP facility, to support our team of nurses and emergency care practitioners'.

A spokesperson said this had happened in eight instances over the past four weeks, adding that this did not 'equate to an entire shift but is rather a variable period of time during the shift when senior nurses/other suitably skilled senior urgent healthcare staff, such as emergency care practitioners, have operated with the support of a GP on call'.

They said: 'We acknowledge that there is a shortage of local GPs who are able to provide out-of-hours cover on top of their busy day jobs and there have been exceptional circumstances where it has been difficult to cover scheduled GP shifts.'

It blamed the local shortage of GPs on external pressures on the available GP workforce, such as 'rising indemnity rates, market forces pushing up hourly rates, reduction in the available GP workforce and a variety of VAT, HMRC and tax issues'.  

An NHS Doncaster CCG spokesperson said: 'We acknowledge that there is a shortage of local GPs who are able to provide out of hours cover on top of their busy day jobs, and there have been exceptional circumstances where our provider – FCMS – has struggled to cover scheduled shifts.

'But a service is guaranteed, using a range of suitable workforce skills, and there is always access to GP advice.'

Doncaster LMC medical secretary Dr Dean Eggitt said that 'the on-call facility is a GP who works from home and can pick up a mobile phone and can answer a problem if the ANP has an issue', adding that this meant that 'the system is not safe'.

He said: ‘I think it is an appalling situation that they are running an out-of-hours service that is supposed to be GP-led, subcontracted to GPs, without GPs. This is NHS care on a shoestring budget, cutting corners and only doing what you can afford - which is poor quality, unsafe care.

'I think it is a safety-critical incident which I personally think should be flagged to CQC as a matter of urgency. I think 24 hours a day patients should be able to contact a senior clinician, a GP, and if that is not available that is a very serious situation that needs to be remedied ASAP.'

The problems faced by out-of-hours providers

GPs on call - OOH - out of hours - urgent care - online

GPs on call - OOH - out of hours - urgent care - online

England and Scotland have struggling with GP cover. In Glasgow and Clyde, out-of-hours services were recently shut down due to a shortage of GPs while NHS Glasgow has had to rely on nurse practitioners to do home visits.

In England, the Department of Health has acknowledged the problem and NHS England recently announced that a scheme that saw GPs reimbursed for hikes in indemnity costs for taking on out-of-hours shifts last winter is set to be repeated during the coming winter.

A GP Survivial survey, carried out earlier this year, suggested one in four GPs have quit urgent care work amid spiralling indemnity. fees.

Pulse has also reported that out-of-hours providers have struggled to compete with the Government's seven-day routine GP pilots, which offered GPs better rates and less antisocial hours.


Readers' comments (31)

  • Where are the Royal Colleges on this why are they not lobbying Parliament about how unsafe the whole service is? More concerned about gongs than patients! Where is the media outcry? Too common to make it a story!(unless it is a foreign doctor!) The NHS is being systematically run into the ground and will not be able to be resuscitated as the goodwill has gone.

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  • Why is bma not screaming from the rooftops
    For the ten millionth count for gross incompetence

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  • This comment has been moderated

  • While there are/were many GP trainees who came to general practice who wanted to be GPs but the big barrier of CSA exam banned them from becoming a GP and this hurdle is still there. RCGP need to look at these facts.

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  • Privatisation done on the cheap, gone wrong. Predicted when the nGMS contact was introduced in 2004 with the option of GP's to opt out of OOH in exchange for 6k. Speaks volumes.

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  • Russell Thorpe

    I'm not part of FCMS however I know the people who run it and I can tell you they are caring professional people who take pride in their service and as such I expect this situation is totally due to them trying to provide the best service with the resources at their disposal.

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  • The BMA, colleges and other quangos are all towing the party line, the members waiting in line to collect their CBE/OBEs, while quietly standing by and watching the (N)HS go down.

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  • this a situation that seems to run much wider than the article suggesests. I work in OOH and am committed to it but I see the gradual errosion of income after expenses and the belief that a non prescribing paramedic can do most of the tasks GPs are good at, driving my colleagues away. The Drs have skills that cannot be replicated by an "OOH Course."

    Last night I had the misfortuen to contact a nearby service for a family member. First off putting a huge delay to access by having 111 as the only access is a huge politically driven mistake. Then when contact was eventually made, the response to a potenially life threatneing was that they may be able to be seen the next day (10 hours later.) I contacted the service via the back door, and was horrified to find the only staffing for most of Lincolnshire last night was a single ANP (who was out on a proptracted visit) and no GP cover whatsoever

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  • Get used to it.

    Been there.
    Done it.
    Chucked my NHS t-shirt...

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  • CQC night time assessments required
    With hefty penalties

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  • This is not an isolated issue and happens in England as well. There now OOH organizations using Paramedics, Nurses , Specialist Nurses (Not ENP but Specialist Nurses such as Cardiac Nurses/Resp Nurses)who see patients very often unselected.

    Although one can easily blame them for being greedy, given the OOH cost per person has dropped from its peak of £50/person in some PCT`s post 2004 to £5-6 in some CCG areas private providers have changed to adapt. Unfortunately this means more referrals to A&E to be on safe side which means eventually the overall cost if high.
    Catch22 situation though.
    Lot of GP`s are fed up due to multiple jeopardy and rising indemnity and hence adding to the shortage of numbers.

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