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‘Punch drunk’ GPs unable to staff out-of-hours services

NHS managers must urgently develop a model to predict how many GPs are needed in the future, otherwise out-of-hours services are likely to suffer warns an influential committee of MPs.

In a report published today, the Public Accounts Committee said the lack of basic GP workforce information at the ‘most basic level’ was a key problem in guaranteeing the future quality of out-of-hours provision.

And GP leaders said that it was important NHS England ‘got a grip’ on an ‘increasingly chaotic and underfunded system’ in out-of-hours.

The report comes after the National Audit Office in July showed that 60% of out-of-hours providers had struggled to fill their rotas, which the GPC attributed to GPs being ‘punch drunk’ from overwork.

It criticises the NHS England and the Department of Health heavily for a lack of oversight on out-of-hours services, and recommends developing methodology for ‘understanding the significant variations’ in costs and patient satisfaction with services in different areas.

The report states: ‘NHS England does not currently have a model to predict how many GPs will be needed in 2020 and does not intend to develop one until it has more certainty about the NHS budget to the end of the decade.

‘In our view, NHS England cannot afford to wait for budgets to be set given the time it takes to train new GPs.’

And the report also calls for an overhaul of the ‘perverse financial incentives’ which undermine attempts at providers working together, such as the payment by activity system in A&E departments. It says: ‘Given the pressures on the NHS budget it is important that NHS England should expedite the redesign of urgent and emergency care services.’

NHS England chief executive Simon Stevens told the PAC earlier this year that the GP recruitment strategy in the past decade had been ‘crazy’.

GPC chair Dr Chaand Nagpaul supported the analysis, saying: ‘Many GPs are working hard to deliver out-of-hours to patients, but they are being undermined by an increasingly chaotic and underfunded system.’

Dr Maureen Baker, chair of the RCGP, said: ‘We desperately need at least 8,000 more GPs in England alone, so we welcome the call by the Public Accounts Committee for NHS England to urgently address this need.’

A spoksesperson for NHS England said: ‘GPs are working incredibly hard, and for less than the cost of a cinema ticket they provide everyone in this country with year-round access to out of hours GP and 111 services.’

‘What’s more the real terms cost of doing so has been coming down year by year. This report, which looks at the position a year ago, is however right to underline the benefits of much greater integration of GP, ambulance, and hospital emergency and urgent care services as proposed in the NHS Five year forward View.’