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Gold, incentives and meh

Out-of-hours services 'broken' as single GP regularly covers 370,000 patients

Out-of-hours services in Northern Ireland are on the verge of collapse, with individual GPs regularly having to cover populations of 370,000 overnight on their own, GPs have warned.

Those in the South and West are being hit the hardest and are almost at the point of having to close completely, RCGP NI said.

Dr Frances O’Hagan, who is chair of Southern LMC and works for the out-of-hours service, described the service in the South as ‘broken’.

She said one GP was left to cover a population of 406,000 patients - although the health board claimed the figure was 369,000 - spread over a large geographical area, rather than the three required on 12 overnight shifts in August.

‘We have been limping along but I would say it is now broken in the South.

‘There is a problem with chronic understaffing but it has come to a real head in the past few weeks.’

Having only one doctor on call used to be rare but is becoming the norm, she added.

A long-standing shortage of GPs plus high costs of indemnity are behind the problem to which the Government needs to find an urgent solution, she said.

‘If I do more than two shifts a month my indemnity rockets so I can’t just do a couple of hours here and there to help out.’

Earlier this month it emerged that an out of hours provider in Doncaster responsible for 300,000 patients had been running night shifts with no GP on the rota.

RCGP NI chair Dr John O’Kelly said they had been warning for a decade that a chronic shortage of GPs in the country would lead to crisis point and ‘hey presto, here we are’.

Training places in Northern Ireland had increased this year from 65 to 85 but this still was not enough and would not solve the current staffing problems, he said.

Coupled with under investment in general practice it had created a ‘perfect storm’.

He added: ‘It’s not surprising out of hours is in trouble and it has a knock on effect on the whole of the health service.’

Young GPs are quite rightly worried about doing out-of-hours shifts over fears it is just not safe, he said.

‘Sat on the minister’s desk right now is a report with recommendations which would solve these problems,’ said Dr O’Kelly ,adding the College had called on them to fully resource GP services.

A spokesperson for the Southern Health and Social Care Trust said the population was closer to 360,000, and it had been a significant challenge to ensure there are enough GPs to cover the 440 sessions a month for some time.

‘We recognise the service is under pressure and at times during the quieter 12pm – 8am period, there is only one doctor on cover but we also have nurses available to provide triage.’

‘The Trust is working with local GPs, the Southern Local Medical Committee and the Health and Social Care Board to help ensure the GPs who currently work in the service continue to do so and to encourage more GPs to work in the service.’

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 Doncaster, a GP out-of-hours provider covering 300,000 patients has been running overnight shifts without any GPs on the rota and having to use only nurses and other healthcare professionals. However, this was on fewer occasions than in Northern Ireland

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 (20)

  • Took Early Retirement

    DON'T tell the GMC or, based on what they said to the juniors, GPs will be told that as it is "unsafe" for patients, they will have to work OOH again or "face disciplinary action".

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  • If only OOH work could be treated as a commercial enterprise . Bankers receive large financial reward otherwise they might leave the country without their important economic savvy. If OOH work was paid at £1000 per hour there would be queues around the block. Obvious hyperbole but some increase in pay would doubtless have the desired effect.

    Pay them and they will come.

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  • Totally agree with 9:55 - the contracts are awarded on a commercial basis and supply and demand needs to be taken in to account.

    What is not acceptable is to win a contract on the basis of safe care, make a bigger profit because you are providing unsafe care (as you are not paying for GPs) and consider that acceptable.

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  • Please do not tell to the single GP-he may also quit worried about the pressure and safety concerns he may face. Protecting patient is GMC slogan-where are they now. I think that is only meant for disciplining doctors

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  • Before everyone gets too heated here, some more information is needed.
    The facts are that contracts for both private and social enterprises are being cut to the bone. CCGs have to take some responsibility and as GPs, we are supposed to have some influence on them so dont be too quick to blame OOH providers. Yes , it is damn difficult to cover the overnights but in this case, the doctor did have the support of what I would imagine are ANPs, who provide excellent triage support. The use of the number of patients covered is a bit sly as well. How many calls per hours? How many visits per shift? You could cover a million patients but if you are only getting 2 contacts per hour then the coverage number is irrelevant.
    Let's not make a crisis in OOHs what with indemnity costs , rising patient demand and changes in the primary care workforce and specifically their change in priorities, much worse by ill informed propaganda.

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  • i agree above
    why are the gmc and cqc not on the case as this is clearly grossly unsafe and unacceptable
    even more..where is the bma
    I would be unhappy to be that lone gp as no doubt if things go wrong the bum warmers in these organisations will hypocritically point the finger at him/her
    the only thing that will make them take action is if the service does collapse with increased aed attendances
    wholly unacceptable
    where is Jeremy hunt?..fiddling about with a vanity waste scheme on apps of course
    where is stevens?..the English nhs is collapsing under your regime(and the current wasteful nhs fragmentation is a lot due to him encouraging blair to start the disastrous failed faked internal market)

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  • GP @10.29

    Totally agree. The GMC says their remit is to protect patients. Then why are they not taking action about poorly resourced services in the NHS, resulting in lengthening waiting times, and doctors collapsing under the strain of work? If their remit is only about policing doctors, who is responsible for the ultimate protection of patients and doctors?

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  • See, this just shows we have a glut of GPs!!

    if 1:370,000, so about 200:70,000,000.

    So 200 GPs can cover the entire population of UK.

    No wonder the goverment is trying it level best to prevent uptake of GP training places, while pushing the existing GPs into early retirement!!

    We are so lucky to have such brain boxes running this smoking joint called NHS!!

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  • More than 70% of OOH calls do not require to be seen urgently. The supply makes the public to use it. The national triage has a big role in increasing the OOH calls, e.g "Thrush at 4.00am"- urgent appointment PCC.

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  • This is NI so there is no cqc or agent Hunt present, we only have our useless politicians to blame here as they are so obsessed with propping up a highly inefficient hospital service that they have totally neglected GP to arrive at this state of affairs, shame on the whole bunch of Stormont MLAs, utterly incompetent lot!

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  • nah ... no worries all that GP needs to do is get resilience training, innovate (skype, new government app, email etc), also don't forget we have pharmacists, PAs, NPs etc to help out. 'never been a better time to be a GP'.

    also with STP they can just merge OOH contracts so if you have two areas covered by two GPs then just merge and get rid of one GP - think of the efficiency and cost savings !

    there is no problem here - move on. the optimum model is to have the population of the UK with one OOH GP - i nominate our CQC head honcho or Sarah Wollaston can come back to GP land to help once she has finished lecturing the juniors.

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  • This ratio is nothing compared to Hampshire . Hows about 1.7 million with 4 GPs ?

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  • The NHS in its present form is unaffordable
    Why has no country on earth copied it ?
    Doctors with no balls to tell the public the truth
    Politicians lying as usual to get votes
    A perfect storm indeed

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  • Yesterday, Hungary announced a 40% increase in salaries of medical staff across the board with doctors and nurses salaries to double by 2019. We are struggling to even remain at 2007 levels of funding in some areas. Happy recruiting NHSE !

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  • Poland has an all out strike on the 24th of September and it won't be cancelled.....the Polish Medical Council is supporting the strike and there is no BMA or JH to sabotage it!

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  • dear 821
    I agree in the sense that the present part privatised nhs perverted and ruined by vastly wasteful ideological non evidence based schemes like the internal market trusts pfi endless failed privatisations and outsourcings..crapita nhs 111 etc etc etc
    it is nonsense to say we 'can't afford it'..we spend 7.8% GDP whereas many in Europe it is 9 even 12 as in Germany.
    I urge all colleagues to support the nhs reinstatement bill as the only way to get back to the original efficient integrated nhs..before stevens finally finishes off the destruction started by himself/blair and then lansley
    this nation cannot afford THEIR nonsense.

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  • And the elephant in the room is...

    ... why are GPs the only medical professionals opting out of their 24 hour responsibility.

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  • @0:45: Er...they effectively had their 24hr responsibility forcibly removed, they didn't "give it up". Yes, some of us voted for a contact which Swapped OOH responsibility for a reduced income (as it happens, I voted against) but it was then made practically impossible to take it back or keep it (Carson standards etc) because the government thought it could do it better and cheaper. Unfortunately they still think this, so pay rates haven't gone up for 10 years, workload has climbed because of NHS direct then 111 - never mind the press - and public expectation is now pretty much divorced from reality. I still do out of hours shifts, but I simply cannot manage over-night ones, even though we did our own on-call as a practice right through to 2004, my body and brain won't take it now. There's no point in blaming GPs for this mess, any more than you would blame hospital docs for how busy and borderline unsustainable it has become to work there, and if it's so cushy a number in GPland now why is there a nationwide recruitment crisis? Either it wAs deliberate on the DoH''s part (increasingly my belief) or monumental incompetence, but it wasn't and isn't GPs fault!

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  • 10 Sep 2016 0:45am

    you make a good point and I think the BMA/GPC should put it to GPs that the public wants you to provide a service (healthcare) to them 24/7 as cheaply as possible and for you to take all the risks for their bad health choices (in many cases). GPs can then choose whether to stay in the NHS or leave. good idea.

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  • Perhaps the £1000/hr isn't unrealistic..... look at what consultants charge for private practice....

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