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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)

  • John Glasspool

    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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