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GPs go forth

Pressurised GP out-of-hours see serious incidents increase by 26% in a year

Exclusive There was a 26% increase in the number of serious incidences reported by GP out-of-hours services to commissioners last year, with GP leaders warning that they are no longer a 'safe pace of work' and that there is an 'urgent crisis' in the service, a Pulse investigation has revealed.

Figures obtained through responses to a freedom of information request from 97 CCGs and health boards across the UK revealed that out-of-hours providers reported 81 serious incidents in 2015, and 76 incidents in 2016. Click here to read some examples of events reported.

In the first nine months of 2017, there had already been 71 serious incidents. Extrapolated across the whole year, this equates to 95 - but this does not take into account the busy winter months, during which time out-of-hours leaders said ‘workload became intense’ for the providers.

One provider in the south west said it experienced a 29% surge in demand over the holiday period, and GP leaders in Wales expressed their concern ‘about the integrity of out-of-hours’ over this winter.

It is also likely that the total number of incidences are higher due to CCGs failing to respond, with one provider covering 1.5m patients saying they had had 84 serious incidents over the three years. 

GP leaders said that out-of-hours services are facing a crisis due to lack of funding and increasing demand.

A Pulse investigation last year found that out-of-hours services are increasingly stretched with one in 10 providers had no overnight GP cover, with increasing numbers of GPs in Wales refusing to do out-of-hours shifts because of unsafe working.

Dr Peter Holden, former urgent care lead for the BMA's GP committee and an out-of-hours GP himself, said out-of-hours services are no longer operating at a 'safe pace of work'.

He told Pulse: 'The system is run by humans and when you look at the millions of calls they handle, while one serious incident is one too many, we have to keep things in proportion.'

He added: 'As we work faster and faster to simply keep up, we are going to make mistakes some of which will be serious and that is not fair to the practices concerned.'

Dr Holden also warned that the number of serious incidents will 'absolutely inevitably' increase if the current patient demand on out-of-hours services continues, adding that 'there are only so many decisions an hour a human being can take, especially if they're high risk judgement calls'.

Dr Zoe Norris, chair of the GPC's sessional subcommittee, said out-of-hours services 'are facing an urgent crisis'.

She said: 'But the government must realise that one of the reasons for increased pressure and difficulty in out of hours services is a serious, long term lack of funding which has left some areas poorly staffed and completely unable to deal with rising demand.

'Many GPs often do not feel adequately supported or able to deliver the standard of care that they feel the public deserves.'

Professor Helen Stokes-Lampard, chair of the RCGP, said: 'Millions of patients receive care through GP out of hours services every year (5.8m in 2013/14 in England) across the UK, and in the vast majority of cases patients receive good care. Nobody wants to see poor care being delivered, particularly not healthcare professionals, but in the rare case that it is, and some of the examples here are tragic, it is important that it is identified and learned from.

'One specific lesson is that GP out of hours services need to be properly resourced, and properly staffed, so that we can deliver the high quality, safe cars our patients need and deserve, when they need it.'

Number of serious incidents in out-of-hours based on FOI responses from 97 commissioners
 YearNumber of serious incidents
 2015 81
 2016 76
 2017 - up to 1 October  71 (96 extrapolated across whole year)

However, Dr Simon Abrams, chair of Urgent Health UK, a representative body for out-of-hours providers, said the increase in reported incidents ‘may well reflect an improved safety culture as opposed to more safety risks’, adding that 'CCGs are becoming more risk aware and changing their reporting requirements'.

The freedom of information responses also revealed examples of serious incidents that have occurred in the south east of England, covered by IC24, including one patient who was ‘found deceased whilst awaiting a visit from out-of-hours in a pool of vomited blood’.

The out-of-hours provider, which covers 1.5m patients across the southeast reported 30 serious incidents in 2015, 29 in 2016 and 25 by late 2017.

Dr Andrew Catto, chief medical officer for out-of-hours provider IC24, said the figures ‘must be viewed in the context of increasing activity year-on-year for integrated urgent care services’.

An NHS England spokesperson said: 'While one serious incident involving the GP out-of-hours service is one too many, the number of incidents stated represents less than 1% of the total number of nearly six million calls the service responds to each year.'

GPs 'horrendously pressured' this winter

These figures come as GP flu consultations increased by 78% in one week, with the statistics showing a consultation rate of 37.3 per 100,000 in England, which is almost three times the expected rate for the season of 13.1 per 100,000.

Both health secretary Jeremy Hunt and Prime Minister Theresa May have been forced to apologise for the performance of NHS services, after NHS England advised trusts to freeze non-urgent care until the end of January.

However, MPs have since voted through a motion calling on the Government to increase funding to the NHS to restore services to normal levels and reschedule the cancelled operations.

The CQC has also recognised the pressure on GP practices by deciding to halt re-inspections of practices with good and outstanding ratings to free up practices' time until the end of January.

Dr Eamonn Jessup, North Wales LMC chair, 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.'

Readers' comments (16)

  • Took Early Retirement

    I used to think that we would watch the sudden collapse of GP services, both in and out of hours. Now I feel we shall just watch bits keep falling off, a bit like a decaying building, to the point where there will be for many people a service in name only.

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  • Council of Despair

    a word of warning - if you have been involved in an incident at a problem site or a site under extreme pressure don't expect the gmc to take that into account. i've learnt that the hard way.

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  • OOH GP is so medico-legally risky in the current climate (under resourced, patient expectation etc.) that I'm surprised any GPs would be willing to carry on doing shifts.

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  • Its safe to work OOH if you refer all and sundry to A&E with a piece of paper.

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  • And we know who will be blamed for the increase in incidents don’t we! It certainly won’t be the DOH or the Minister for Health who take no responsibility for their actions ever. I despair even more than usual!

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  • It makes sense. Greater the number of people attending OOH, greater is the risk of incidents. GPs working there factor the risk when they volunteer for duties and accept this risk. So what's the problem:)

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  • @anonymous Locum GP:
    I agree. Blaming the individual when something goes wrong is a fine distraction from organisational failure. And the minimum an OOH GP should be able to expect from their provider is some effort to manage demand or else at least stand by their staff when things go wrong. But the crisis has led to increased anxiety to be made accountable, to blame and shame of the already rare doctors willing to do the job, the defense organisations colluding with NHS England and the GMC in encouraging submission instead of whistleblowing and as a result further deterioration of GP moral with unwillingness to do the job.
    But as long as the public does not sympathise - doctors earning too much in their opinion - and the media having such a hold on public opinion that game goes on.

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  • The regulators should never have allowed this situation to arise in the first place but instead they chose to stay silent because they were making money. The MDOs have been aware of the problems for some time and priced this risk accordingly. We need an investigation into the actions of the GMC in particular and why it has been blaming individual doctors for systemic problems.

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  • Is it simply that OOH systems can not offer an appointment in 2 weeks or simply say there are no appointments available so in hours work spills into OOH
    This is because of enormous pressures on GP practices with lower funding, high costs including high locum costs and extra work and demands placed on them by the CQC CCGs younger colleagues not wishing to work as long hours as GPs did previously, increased safety systems, longer more complex consultations etc
    The NHS and social care need an immediate funding boost to deliver consistently high quality safe services or perhaps we should subpoena Jeremy Hunt for any legal claims where overwork is a factor or summon him to GMC hearings in such cases
    SOS save our NHS !

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  • trumphole NHS?

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