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At the heart of general practice since 1960

'We are constantly firefighting'

A Pulse investigation has found that in the past 12 months, staffing in out-of-hours has reached rock bottom with around one in 10 providers admitting to periods with no overnight GP cover, affecting some four million people. Dr Alan Woodall, a GP partner in Wales, tells Pulse staffing in out-of-hours has reached ‘safety critical’

The pressures on the out-of-hours service are approaching critical. I’m the standby doctor for our excellent out-of-hours service, but I cover an area that stretches 800 square miles on the evening shift because there is nobody else.

dr alan woodall 002large christopher jones 330x330

dr alan woodall 002large christopher jones 330x330

It only takes two sick people at either end of the patch to result in doctors having to be pulled in from other patches, leaving their area uncovered; we are constantly trying to firefight demand.

Because of the rota gaps and pressure on resources, we will have to employ a lot of urgent care practitioners and paramedics to help us cope. They are skilled but they’re not medically trained, meaning the doctors on duty will also have to provide remote advice.

When we are busy, the callback times can be four or five hours, and our time is often taken up dealing with inappropriate requests. A couple of months ago, a guy phoned up to say his girlfriend was coming over and he realised he hadn’t ordered his Viagra, so could we supply it. We have a contractual duty to call that man back and explain why his request was inappropriate.

It is falling due to a dwindling band of older GPs like me to deliver out-of-hours care and it is probably not sustainable. Indemnity costs are one reason for this situation, but also most out-of-hours GPs haven’t had a pay rise for 10 or 15 years. My rate of pay is £65 an hour – our locums charge more than that for a day shift.

Dr Alan Woodall is an out-of-hours GP in England and a GP partner in Wales

 

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Readers' comments (8)

  • This is crazy, unsafe, and one wonders why you continue...

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  • Don't firefight pull out of the service let the fire burn and see if the government can put it out.I bet they would poor more petrol on it instead.

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  • Surely gmc duty of care suggests not to continue working in such an unsafe setup?

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  • Azeem Majeed

    Thanks Alan. Good points.

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  • Situation APPROACHING critical? I say check your premises for you have arrived. Until a death or two happens with the predictable yet surfeit outrage ensuing, nothing is likely to change.And even then, who knows?

    Mr Firefighter, heres a 5L can of a liquid that looks like water to help you out.I must declare however, I am completely anosmic......

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  • Horrendous . Very frightening work. And this is the way in-hours care will go too, with 'new ways of working'- small numbers of GPs will be remotely supervising, prescribing for and taking on the risk for various others- nurses, paramedics, physician assistants, pharmacists etc. all with a certain amount of knowledge and experience but working to algorithms or narrow areas of expertise and missing details through lack of clinical acumen and breadth of knowledge. Already general practice has become disjointed by multiple chronic disease management clinics - not without benefits, granted, but increasing amounts of GP time spent responding to requests for prescriptions that are usually but not universally appropriate. I trust my own history taking and examination, and I know the capabilities of my close colleagues that I supervise. There is no way I would want to take on the risk of supervising others on anything near the scale described above, particularly remotely, that I do not work with closely and know well. Indemnity costs are quite rightly high - the risks are astronomical.

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  • Frankly speaking:

    at the heart of OOH care is effect triage:
    from my experience of 4yrs working in OOH, the majority of clinicians give inappropriate visits or appointments which create the delays.
    "OOH GP's exist to ease the burden on ambulances and A&E"...?

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  • Many Doctors would love to do more OOH work but do not because
    1. Indemnity High
    2. Staffing deliberately kept low to maintain budgets or profitability
    3. Lack of respect by the service itself which simply requires a medical scapegoat
    For every other component.. walk ins, paramedics, patients calling but refusing care, transportation to hospital
    4. Doctors treated as expendable
    5. For those OOH linked to A&E:
    Triage is often grossly inappropriate and simply a means a diversion of workload which still needs A&E investigation..or as an underhanded route to divert to admitting teams without working up a case
    6. Poor staffing levels meaning on one site you may get the workload from several other sites..
    7. or you may be singlehanded. Facing a long list of patients to call
    The service will require patients to be called in a time order
    When Doctors could easily triage further and prioritise children and those with more urgent presentations

    Lions led by Donkeys
    Lions fed up and tired

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