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Seven-day GP access scheme causes ‘mayhem’ in out-of-hours workforce

Out-of-hours providers have been left struggling to recruit GPs for shifts after the Government’s seven-day GP access pilots began offering double the hourly rate, which has caused them ’mayhem’, leaders have warned.

The chair of the Northern Doctors Urgent Care (NDUC) group criticised NHS England for the lack of workforce planning in the Prime Minister’s Challenge Fund, which had seen their workforce ‘cut by a quarter’.

NHS England head of primary care Dr David Geddes, a GP in York, said he was aware of the workforce issues thrown up by the pilots drawing from a limited pool of GPs.

He added that he had fears this could be exacerbated by the rolling out of ‘vanguard’ models of care that will see GPs and consultants working within the same organisations .

It comes after the official evaluation of the seven-day GP access pilots revealed that they were ‘competing’ with out-of-hours providers for GPs, leading to incentives that were ‘unsustainable’ in the longer term.

Speaking at the Urgent Health UK annual conference in Macclesfield this month, NDUC’s John Harrison explained that challenge fund pilots had ‘come barrelling in and caused mayhem.’

The out-of-hours organisation has three locations within the South Tees Access and Response (STAR) seven-day pilot scheme, which operates across 47 practices in Middlesborough, Redcar and Cleveland.

Mr Harrison told Pulse that out-of-hours organisations had always had to carefully manage local GP workforce as only a limited number want to work out of core hours, but they could not compete with Challenge Fund schemes offering ‘£100 an hour plus’ for shifts.

He told delegates: ‘In Teeside, the local doctors won a Prime Minister’s Challenge Fund bid. They couldn’t get enough [GPs] for themselves to cover their rotas, so what do they do? They put it out at double the out-of-hours rate, £100 an hour plus, where the rest of us are dealing with about £47 to £50 an hour. We lost a quarter of our workforce in a matter of a couple of weeks.

’All of us manage our local workforce, there’s not a lot of GPs who want to work in out of hours, then a scheme like this comes barrelling in and causes absolute mayhem.’

A spokesperson for the STAR scheme told Pulse that rates had been set after consultation, and was in line with national locum and out-of-hours rates as the rate of £90 does not include sick or holiday pay, or tax and pension deductions.

The STAR spokesperson added: ‘Out of the 32 GPs who agreed to work one or two shifts in October, less than 10 had worked or were currently working for Northern Doctors Urgent Care (NDUC) and most of these said they would continue to provide out-of-hours cover for NDUC.’

The North East has some of the most acute workforce pressures in England, with just 51% GP training places filled after two rounds of recruitment, and education bosses conceding workforce was being drawn to London and the South to their detriment.

Dr Geddes said he was all too aware of the pressures presented on primary care services by extending GP hours.

He said: ‘We are all fishing from the same pond. We know that has happened with the Prime Minister’s Challenge Fund. I personally worry that it may happen with vanguard sites as well, and we’ll end up with practices having difficulty recruiting around the periphery of a vanguard site.’

The evaluation scheme said: ’Wave one pilots did experience some capacity issues, which manifested themselves often as difficulties in recruiting or competing with OOH providers for GP time.

’To date some pilots have relied on incentivising GPs to resource PMCF initiatives and this may not be sustainable in the long term. These are issues likely to face all local health economies progressing towards extended access service models.’


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