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Out-of-hours shifts being run with no GPs due to recruitment crisis



A GP out-of-hours provider covering 300,000 patients has been running overnight shifts without any GPs on the rota.

NHS Doncaster CCG said its out-of-hours provider FCMS had struggled with a shortage of GPs, forcing it to staff shifts with only nurses and other healthcare professionals.

It said that the patient service had always been ‘guaranteed’ and the other healthcare professionals had ‘access to GP advice’ – but the LMC has said simply meant GPs at home picking up calls from other healthcare staff who were running the service on their own.

The provider also admitted that in two instances over the past four weeks, there was no GP on-call whatsoever.

GP leaders in the area said it was an ‘appalling situation’ that was a ‘patient-safety critical incident’.

This is the latest in a series of incidents involving out-of-hours providers struggling due to a lack of GPs willing to work the extra shifts for a variety of reasons, including rising indemnity costs and increased in-hours pressures.

FCMS – which runs the out-of-hours cover out of its urgent care centre co-located with the A&E department at Doncaster Royal Infirmary – said it had run a number of shifts led by ‘a combination of experienced nurses and emergency care practitioners, with an ability to prescribe, but without a physical GP presence’.

It said that during the past four weeks, ‘one overnight shift of eight hours was not covered and three hours of another shift were not covered’ by a GP at all, while ‘other shifts have been covered through an on-call GP facility, to support our team of nurses and emergency care practitioners’.

A spokesperson said this had happened in eight instances over the past four weeks, adding that this did not ‘equate to an entire shift but is rather a variable period of time during the shift when senior nurses/other suitably skilled senior urgent healthcare staff, such as emergency care practitioners, have operated with the support of a GP on call’.

They said: ‘We acknowledge that there is a shortage of local GPs who are able to provide out-of-hours cover on top of their busy day jobs and there have been exceptional circumstances where it has been difficult to cover scheduled GP shifts.’

It blamed the local shortage of GPs on external pressures on the available GP workforce, such as ‘rising indemnity rates, market forces pushing up hourly rates, reduction in the available GP workforce and a variety of VAT, HMRC and tax issues’.  

An NHS Doncaster CCG spokesperson said: ‘We acknowledge that there is a shortage of local GPs who are able to provide out of hours cover on top of their busy day jobs, and there have been exceptional circumstances where our provider – FCMS – has struggled to cover scheduled shifts.

‘But a service is guaranteed, using a range of suitable workforce skills, and there is always access to GP advice.’

Doncaster LMC medical secretary Dr Dean Eggitt said that ‘the on-call facility is a GP who works from home and can pick up a mobile phone and can answer a problem if the ANP has an issue’, adding that this meant that ‘the system is not safe’.

He said: ‘I think it is an appalling situation that they are running an out-of-hours service that is supposed to be GP-led, subcontracted to GPs, without GPs. This is NHS care on a shoestring budget, cutting corners and only doing what you can afford – which is poor quality, unsafe care.

‘I think it is a safety-critical incident which I personally think should be flagged to CQC as a matter of urgency. I think 24 hours a day patients should be able to contact a senior clinician, a GP, and if that is not available that is a very serious situation that needs to be remedied ASAP.’

The problems faced by out-of-hours providers

GPs on call - OOH - out of hours - urgent care - online

GPs on call – OOH – out of hours – urgent care – online

England and Scotland have struggling with GP cover. In Glasgow and Clyde, out-of-hours services were recently shut down due to a shortage of GPs while NHS Glasgow has had to rely on nurse practitioners to do home visits.

In England, the Department of Health has acknowledged the problem and NHS England recently announced that a scheme that saw GPs reimbursed for hikes in indemnity costs for taking on out-of-hours shifts last winter is set to be repeated during the coming winter.

A GP Survivial survey, carried out earlier this year, suggested one in four GPs have quit urgent care work amid spiralling indemnity. fees.

Pulse has also reported that out-of-hours providers have struggled to compete with the Government’s seven-day routine GP pilots, which offered GPs better rates and less antisocial hours.