Exclusive GP out-of-hours providers have been thrust into competition with practices over a ‘limited pool’ of GPs to work on Easter Saturday after NHS England announced incentive schemes to keep practices open.
This comes as medical leaders reported variable uptake to local enhanced services created at short notice in response to a call from NHS England for GP practices to open for a three-hour shift over Easter in a bid to prevent a repeat of the Christmas holiday A&E meltdown.
A Pulse investigation showed that between a sixth and a third of practices were taking up LESs specially created for the weekend in areas where financial incentives were offered, while out-of-hours services will be left to tackle the whole burden elsewhere.
GPC deputy chair Dr Richard Vautrey said that in Leeds, where he is assistant medical secretary on the LMC, ‘around 20 practices’ will be opening at some point of the bank holiday weekend.
He said: ‘This scheme is supported by additional funding for those who have volunteered to take part and also links to the extended hours scheme that one of the CCGs has developed which new long-term funding they’ve invested in general practice.’
But other GP leaders warned that the one-off payment incentives coupled with smaller indemnity costs incurred when operating from the practice rather than through out-of-hours were having the unintended consequence of drawing GPs away from working out-of-hours shifts this weekend.
Devon LMC medical secretary Dr Mark Sanford-Wood said: ‘The main concern locally is that the offer may actually precipitate destabilisation of out-of-hours services.
‘Our local out-of-hours provider Devon Doctors on Call is proud that its services are largely delivered by local GP partners. Of course, if these people can earn better rates of pay for working in more protected circumstances within the structure of their own practice then they are likely to plump for that and avoid out-of-hours work over Easter which is always very difficult.’
Out-of-hours providers confirmed there was an issue, with Integrated Care 24 medical director Dr Mark Reynolds telling Pulse that it had caused ‘significant difficulty’ in ‘one or two areas’.
Dr Reynolds, whose business covers East Sussex, Brighton and Hove and Kent, said: ‘My plea is, could these ideas be thought about a bit more in advance and better coordinated, and also priced so as not to compete and draw GPs away from the service that will still be doing the vast bulk of the work.’
In Stockport, Dr Jon O’Malley, medical director of local out-of-hours provider Mastercall Healthcare warned that all providers were ‘fighting over a dwindling number’ of GPs.
He added that while they would await the CCG’s evaluation of Easter opening pilots he felt services might be being duplicated.
He said: ‘I’m not overly sure it’s going to make much of a difference. It is paying twice for the same service, that’s my concern.’
The concerns come as Pulse reported that GP recruitment problems had left more than half of out-of-hours providers struggling to fill shifts even in normal circumstances, and some out-of-hours providers did foresee problems with Easter staffing.
This included southeast London out-of-hours providers SELDOC, which offered a pay increase and confirmed rotas ‘months in advance’. However, despite this SELDOC chair Dr Emma Rowley-Conwy said that ‘a last-minute offer’ from the CCG would see Lambeth GP practices ‘very well paid’ and had resulted in 10 practices agreeing to open for four-hour shift.
She said: ‘I agree that the underlying pool of duty doctors is limited, and there is competition.’
In other areas, LMC leaders’ main concern was a lack of timely information from area teams and CCGs about incentives.
Derby and Derbyshire LMC executive officer Dr John Ashcroft said the area team has had to contact practices this week to confirm who still intends to participate in the local enhanced services.
He said: ‘It’s all been rather confusing. A lot of practices who said they would open appear now to have pulled out of this because the money is less than expected, or they haven’t been able to find staff to cover, or doctors to cover.’
In some areas, LMCs claimed no GP practices had responded to calls for extra opening.
Northumberland LMC chair Dr Jane Lothian told Pulse: ‘We don’t have a scheme. All our practices are exhausted and need a break’.
Meanwhile, lay secretary of Gloucester LMC Mike Forster said: ‘Except in Cheltenham and Gloucester, the Easter period [in our LMC area] will be covered by the new out-of-hours service which took over the contract yesterday.’
An NHS England spokesperson told Pulse local area teams and CCGs were responsible for ensuring GP services were available, but added: ‘Primary care services are vital for patients, whether delivered by GP practices or out of hours services, and across the country plans are in place to ensure appropriate services are available for patients over the Easter weekend.’