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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)

  • 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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