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GPs buried under trusts' workload dump

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)

  • Edoardo Cervoni

    The findings comes hardly as a surprise. I have worked OOH for well above 2 decades and the trend has been worsening. Interestingly, this was not due to an "increased seriousness" of the illnesses triggering the request for OOH appointment. "Au contraire". In relative terms, it has been the other way around. The increaing pressure has been due sometimes to services such as 111, other times it has been following some "awareness campaigns, often it has been linked to social isolation, and frequently to "expectations" that something should be done even if dealing with self-limiting, minor illnesses. Political and public expectations have increased. Unfortunately, most have been unrealistic and being good is not always synonymous of being nice. Under pressure, human errors do take place.

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    1. Patients calling 999 then refusing to go to a+e .... see gp
    2. Inappropriate A+E triage .. chest pain shipped out to see gp
    3. NHS direct phone triage delays to serious cases .. appt several hours later to see gp
    4. Case clearly needing admission on phone ... come see gp ???
    5. ethos of gp somehow being able to avert cases from A+E ... Yes if appropriate to do so .. otherwise by taking huge risks
    The service loves risky doctors ... while they are lucky everyone happy
    when their luck runs out they can be scapegoated
    expendable assets

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    Organisational issues often lead to complaints... even when these have nothing to do with the doctor and reflect more on the service and patient in-appropriate expectations..
    You can be sure that at appraisal time the ethos will be that it is all a doctor related issue
    deny it ....and you lack insight
    be sure to document and reflect very very thoroughly.

    How many of these serious incidents related to doctors or unsupported nurse practitioners???

    How many were locum doctors placed in riskier positions by understaffed ooh

    How many times have you taken a locum position in ooh .. only to arrive and find you are the only doc on ... +1 if you are lucky???

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  • Vinci Ho

    You see
    The way it goes , the government will eventually say OOH GP service is too unsafe to carry on . With the ‘evolution’ of integration into Accountable Care Services (ACS) run by Accountable Care Organisations (ACOs). There will be eventually no such things called in hours or out of hours.
    Primary care and GP will be 24/7 Services as there was no such thing called out of hour secondary care services previously.
    How are ACOs funded or ‘adequately’ funded is another matter. This government and its health secretary are really not interested.

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  • As a front line busy GP I have noticed a very worrying deterioration in our local OOH services. Often the GP slots are filled with nurses and I have been reliably informed that IC24 when full ask 111 to refer patients directly to A&E. Those courageous doctors who continue to work for OOH are being pushed to the limit and many are stopping. Our CCG who commissioned the OOH cover still pay them the full amount even if 1/3 of Dr shifts go unfilled. What kind of inadequate contract is that? I believe OOH will be generating the most alarming headlines this year.
    Heaven knows how it can be fixed. The worse it gets the less doctors will be prepared to work in it.

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  • Siraj Shah

    GO to your GP syndrome must stop; why does everyone from milkman to a consultant has to say to a patient go and see your own GP! I think they all pass on the buck to protect their own asses.

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