Exclusive GPs working for the coronavirus telephone hotline claim they have been facing incorrect, delayed or ‘complete non-payment’ for their work on the service.
They told Pulse that the Covid clinical assessment service (CCAS) has ‘myriad’ problems, which also include rostering software that crashes ‘for hours at a time’ when clinicians try to book shifts.
One GP said they were concerned about eviction after they were unable to secure shifts and pay the bills.
A spokesperson for the South Central Ambulance Service NHS Foundation Trust (SCAS), which runs the CCAS, told Pulse that while there was a ‘delay’ in setting up some payments, ‘all payments are now being made in line’ with local schedules.
They added that concerns will be ‘investigated’ and ‘issues’ with the rostering system are currently being addressed.
The CCAS was set up as an expansion of the NHS 111 service at the start of the pandemic, to offer further triage to Covid-19 patients for whom the 111 algorithm cannot determine whether hospitalisation is required.
One locum GP, who spoke on behalf of an online support group of 269 GPs who do sessions for the CCAS, told Pulse that they and other GPs are ‘not being paid for months at a time’.
While payment is due a month after the work is completed, they only received payment in late August for work done in May and June, they said.
The GP, who wished to remain anonymous, added: ‘I’ve got a mortgage and bills to pay. It didn’t help that there was just no pay in July for what I’d done in June and a month later [it has] come through with incorrect payment for May.’
But this is not an isolated incident, with the ‘majority’ of people on support group reporting problems and having to ‘chase payslips’, they added.
They said: ‘Every other post is about pay and delayed payment issues. Eventually something is coming through, but I think everyone has had the issue of at least late or incorrect payment – and a few have had complete non-payment.
‘You may get money in your account, but you can’t really verify whether it is correct [and] what the deductions are. And even when you do get [a payslip], the majority of people are finding that it’s just not accurate in terms of the hours that you’ve worked.’
Meanwhile, some GPs are yet to receive promised payments for initial training, they added.
Alongside issues with pay, the CCAS GP group representative told Pulse that the ‘obstructive’ rostering software crashes for ‘hours at a time’ when shifts are released for clinicians to book.
They added: ‘The website itself is horrendously slow to navigate. With the best IT and internet connection in the world and multiple browsers, every clinician on the forum has had problems.
‘I’m spending five and a half hours of my own unpaid time simply to try and book a shift. Hours at a time have been lost where other work could have been done and other patients could have been seen.’
Some locums who are unable to secure shifts have been struggling financially, they added.
They said: ‘[One GP] literally got zero shifts for the coming four or five weeks. He has been struggling paying his bills [and] mortgage and he doesn’t even have a family. He’s worried about eviction potentially.’
With so few shifts on offer, it’s ‘not common sense’ to continue giving shifts to returning retirees ‘when everyone else is struggling’, they added.
While the service was ‘severely over-doctored’ in May – with about 120 to 130 clinicians working most shifts – there has been a ‘significant reduction’ to around seven to nine doctors now working each shift, they said.
They told Pulse: ‘Even patients that were in a six to 12 hour callback were being called within less than 20 seconds because there were just far too many clinicians and it was a complete waste of resources.
‘Now we’ve had the opposite problem. Since the beginning of August, we’ve been struggling and patients have been waiting long times for callbacks for quite severe problems.’
And GPs working for the CCAS are concerned there are no senior clinicians to consult while on shift, they added.
Dr Richard Fieldhouse, chair of the National Association of Sessional GPs – which set up the online support group – told Pulse that the issues over shifts and rostering are causing a situation of ‘feast and famine’.
He said: ‘Earlier in the summer, we had stories of GPs just sitting around literally fighting over who was going to see the next patient. Then what CCAS did is pretty much over a 24 hour period just cancelled a whole load of sessions.
‘Locums are turning up to do their allotted slots to find fast-approaching a thousand patients waiting to see 50 doctors. It’s having an impact on patients as well.’
He added: ‘You name it, it’s happened. I’ve heard stories of non-payments, incorrect payments, some [GPs] have been paid too much, some haven’t been paid for training.’
While the CCAS is ‘not very well organised’, the problems less ‘conspiracy’ and ‘more cock-up’, Dr Fieldhouse added.
However, communication has been ‘poor’ and the service has been ‘unresponsive’ to GP concerns, the anonymous locum told Pulse.
They said: ‘They have a few webinars and a lot of people have raised these questions but they don’t seem to be giving any satisfactory response. They’ll say they’ll look into things but nothing seems to be being done.’
‘It just seems like you can’t get anywhere. I’ve raised a formal complaint about this rostering system and I still haven’t heard back.’
A spokesperson for the SCAS said issues with pay were either resolved or under investigation.
They said: ‘GPs are remunerated through two routes – those directly employed are remunerated monthly by SCAS and we will investigate the concerns about payslip availability.
‘For those supporting the service through normal primary care contract payments, individual reimbursement is made by the practice. While there was a delay in setting up some practice payments, all payments are now being made in line with the local primary care payment schedules.’
They added: ‘We are aware of some issues with the rostering solution being used for the CCAS and have been working with the supplier to try and resolve them. Currently there is a significant demand from GPs wanting to book shifts.
‘Many of our staff are attempting to book shifts simultaneously which has been causing issues for the system provider. The supplier is addressing this.’
The spokesperson told Pulse that the number of GPs required declined during the summer due to a ‘significant reduction’ in public demand, leading to ‘some GPs not having access to the same level of work as during the initial phase of the pandemic’.
‘As we are now seeing demand increase again, we have increased the level of staffing in the service to ensure patient safety at all times’, they added.
The CCAS GP group previously told Pulse that NHS England is expanding the scope of the telephone hotline towards a more general clinical assessment service ‘on the sly’ – and without increasing their pay.
They warned this could destabilise primary care as a whole by ‘devaluing’ the work, with CCAS GPs paid just £50/hour.
According to the new NHS People Plan published last month, more than 500 retired GPs have returned to work alongside 1,000 locums and other GPs for the CCAS.
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