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GP out-of-hours cooperative cuts staff and pleads with NHS to pay more



A GP out-of-hours provider, which has been forced to make redundancies after falling into financial difficulty, is asking for an urgent rise to its NHS contract values.

GP out-of-hours co-operative Shropdoc said its financial woes were a result of not being paid sufficiently by health service commissioners in the first place because of the ‘competitive’ tender environment in England; a delay to an expected NHS 111 contract; and workforce shortages.

Shropdoc, which provides GP out-of-hours services in Shropshire County, Telford and Wrekin, and Powys in Wales, has therefore gone to the CCGs and health board to request its contract values are urgently uplifted.

In a letter sent to GP members, and seen by Pulse, Shropdoc chair Dr Russell Muirhead said that the not-for-profit organisation is working on a financial recovery plan which has resulted in redundancies.

He said this included the ‘mutually agreed’ departure of CEO Ian Winstanley, who will not be replaced until finances are ‘under tighter control’.

Shropdoc has also made redudant its director of transformation, operations director, performance manager and its programme support manager.

The letter added that the competitive tender environment in which out-of-hours providers operate has made it harder to maintain financial balance.

It said the reason for running its out-of-hours contract at a remuneration lower than the cost of delivering them was ‘to ensure that when the CCG commissioners put the out-of-hours service out to tender, we were in the best position to win it against serious competition’, and it had been subsidising this loss with profit from other contracts.

But the letter added that ‘unfortunately, with the 111 process dragging on, the date for any tender is now approximately 2019 and we cannot sustain this position until then’. 

Dr Muirhead said: ‘We have met with the commissioners to explain our position and to ask for their financial support, and to quickly renegotiate the value of the contracts for the current financial year.

‘None of the contracts delivers a surplus so it is more than just reaching a cost neutral position, there has to be some percentage of surplus to ensure the contract is sustainable. We do not know if this will be possible and to what extent they will support us.’

He also said that an initiative to address GP and clinical workforce shortages by developing a new ‘urgent care practitioner’ role had come ‘at a greater cost than we planned’.

But this is now yielding some benefits and, along with the 30% of Shropdoc business from non-out-of-hours contracts, will be part of the long-term financial solution.

Dr Muirhead concluded: ‘I realise that this message contains some worrying news but it is where we are as an organisation and you need to be aware of this. Every member of staff is working hard to secure our future and their efforts are very much appreciated.

‘We are not out of the woods yet by any means and more work will be required over the coming weeks and months. I will keep you informed as the situation develops.’

Dr Muirhead told Pulse that Shropdoc, whch has just had ‘an excellent CQC’ report, had not allowed its service quality to be affected.

He said: ‘The service is being sustained at its existing levels. There is no patient risk.

‘This is a combination of both internal issues built up over time and negotiations with the CCGs and the health board over contract terms and conditions.’

It comes as Pulse has shown how GP out-of-hours services keep hundreds of thousands of patients out of A&E each year.

But they are on a knife-edge and services are stretched to find staff and make a profit as they are undercut by extended hours initiatives.