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GPs go forth

Recruitment crisis leaves 60% of out-of-hours providers unable to fill gaps in GP rotas

The GP recruitment crisis is hitting out-of-hours providers who are struggling to fill shifts and meet national quality requirements because GPs are too ‘punch-drunk’ exhausted to work beyond their regular hours.

The Out-of-hours GP services in England report by the National Audit Office – released today – found that 59% of OOH providers had unfilled rotas from September to December last year, while one in four providers were unable to meet quality targets around responding to urgent cases.

The NAO said that these problems ‘often related to staffing’, as recruiting out-of-hours GPs had become ‘more difficult’ due to increased in-hours workloads and the rising costs of indemnity insurance.

Out-of-hours leaders told Pulse that even attracting agency staff is becoming more difficult, while the GPC said that GPs are too ‘punch drunk’ to work out-of-hours shifts.

It comes after Pulse has reported that some CCG leaders have had to inject extra cash to support out-of-hours services due to major problems with filling out-of-hours shifts.

The NAO, which is the Government’s official auditing body, looked into out-of-hours services between September and December last year.

It found that generally the quality of provision remained high, but 26% of providers failed to comply with the target to triage 90% of urgent cases within 20 minutes.

The report states that missed responsiveness targets were ‘often related to staffing.’

It says: ‘Sometimes providers failed to roster enough clinicians during peak periods, for instance over bank holiday weekends. More generally, providers told us that recruiting and retaining enough GPs was difficult.’

The report adds: ‘The providers we interviewed preferred to employ local GPs who were familiar with local health services. But not all local GPs want to work out-of-hours. Some providers said it was getting harder to attract GPs for a number of reasons.’

These included a ‘general rise in in-hours’ workload for GPs, as well as the increased cost to of indemnity insurance which ‘providers reported has markedly increased in the last two years’ and has led to some health bodies having to support GPs to obtain indemnity.

The report explains that despite the large number of providers reporting gaps, 98% of rota hours are filled.

But Dr Emma Rowley-Conwy, chair of the SELDOC out-of-hours provider in south-east London, said they are increasingly dependent on agency workers to cover gaps.

She told Pulse: ‘Generally, yes it is difficult to recruit, yes we have gaps in our rota. Yes, we are now actually even struggling to achieve our [National Quality Requirements] and this is impacting on our NQR performance.’

‘Sometimes [we can’t even get agency cover] and we’re just not able to fill the shifts at all. We’re using agencies a lot more, but then on Friday nights somebody might ring and say “I’ve cancelled I’m sick” and then it does actually fall apart.’

‘We’re making use of text a lot to try and get GPs, but they are exhausted. If they’ve already done a lot of work in their practice, then they don’t want to come and work out of hours.’

She said that the problem in the long term is a shortage of doctors overall.

Dr Peter Holden, GPC lead on urgent and emergency care and a GP in Matlock, Derbyshire told Pulse that the spiralling cost of indemnity fees meant that out-of-hours work financially unviable for many GPs.

Dr Holden told Pulse: ‘The bottom line is, it’s not surprising. This is the market at work, once you get to about 30 sessions a year; if you work anymore you’ve got to work to about 50, for nothing, just to pay the indemnity premium. It’s a huge problem.’

‘The other problem is that out-of-hours services are struggling because… [they] are actually punch drunk from a day’s work.’

‘We’re just knackered from a day’s work. We can’t then go and work out of hours. So therefore there are fewer of us working for it and the price has gone up.’

An NHS England spokesperson said: ‘NHS England welcomes the report and will consider it carefully and respond fully in due course.  We are confident that the new out-of-hours assurance process brought in earlier this year (March 2014) is robust and has addressed many of the issues outlined by the National Audit Office.’

‘We will however carry on developing processes to ensure patients continue to receive high quality care and access to a GP outside of surgery hours.’

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Readers' comments (26)

  • Market forces are Supply/Demand based.The powers that be will not beable to control the disintegration of primary care.IT WILL COST THEM one way or another(and us Im afraid)

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  • OOH rates are far too low.

    When you are earning less than an on-call plumber (and paying indemnity) there is only one decision.

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  • Out of hours is an interesting paradigm for what is happening to the rest of UK general practice. There is no surprise that a chronically underfunded, part-privatised service struggles to deliver, so if you think things are bad now, you ain't seen nothing yet.. An ordinary working day for the average GP now extends well into an OOH shift which is impossible to get to in time, let alone covering all the other requirements for commissioning, revalidation and CQC. As GPs struggle to fill positions within their own practices and the deaneries are unable to recruit enough trainees the writing is on the wall for OOH. The government could fix this if it wanted to. GPs need to enjoy the same trust indemnity arrangements given to their hospital peers, it needs to be funded to the extent that surgeries can back fill gaps in their rotas and it need to attract a premium like overtime in any other business.

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  • Took Early Retirement

    Brilliant news!
    Let's hope the whole thing crashes and burns during the summer holidays.
    the winter, with its respiratory illnesses will be a testing time too- if we get that far without a collapse.

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  • Bob Hodges

    I went into AF during an OOH shift last week (14 hours into a 15 hour day). Luckily it only lasted a couple of minutes. I'm 38 years old and now have all the excuse I need to do LESS out of hours work without feeling 'guilty' about leaving the servicing up the creek.

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  • One of the largest OOH providers has decreased the number of doctors and is using ANP`s for overnight shifts including home visits. The ambulance callouts and missed diagnoses are creeping up. This is on top of 111 already increasing the ambulance callouts and A&E attendences.
    Routine visits end up being blue light calls as patients are so unwell and occasionally end up as death confirmation.
    Unfortunately they are only responding as any private company will do with decrease in GP availability- cut its own losses and pass on the problem to others i.e A&E and ambulance service.
    It maybe worthwhile for PULSE to obtain staffing levels for each OOH and proportion of routine and urgent home visits under FOI and publish same.

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  • with the show run by without accountability BY NHS not following statistics of cost savings short term and long term with job satisfaction for GPs;where Studies by Prof Tony Barnet in dangers of using sulphonylureas as 2nd line treatment antidiabeticsand costsavings in avoiding these;;and studues from newcastle group showing costsavings and lowered morbidity/mortality in patients by allowing GPs to prescribe slightly more expensive medication to save long term and short term escalating costs, we will continue to have demoralised General Pratitioners unwilling to work in such a suicidal environment

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  • When I in GP, till I left having seen the light, I also did some OOH sessions but stopped because I simply could not get to the start of a session on time because of GP workload, the MDU also worried me by loading my premium if I did OOH, and physical exhaustion of working most days of the week just to keep up. OOH is very unpleasant and not at all the way medicine should be run. Going from one patient to the next with no thinking break, completing your notes on a computer in a moving car and being harassed if you take your time and try to do things the way you know they ought to be done. I am now re validated and working in a completely different area and now like going to work. In your face Jeremby Bunt.

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  • Blame the crazy MDU fees!

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