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12 July 2018
GP out-of-hours services in Wales are failing to meet national standards and the introduction of the new NHS 111 service will only partly address the problem, the Wales Audit Office has warned.
The report, which follows an government-ordered investigation of out of hours in every health board in the country last year, found services under strain due to poor staffing and morale.
And despite the Welsh Government setting a target of all health boards meeting national standards by March 2018, the latest data suggests they are ‘some way off’, the WAO said.
The report said health boards are struggling to fill shifts and are trying to reduce reliance on GPs by expanding the range of professionals working in out of hours but progress is patchy. At the time of their visits no health board had a specific workforce plan for out of hours, the WAO said.
It also pointed out that funding for out-of-hours services had fallen by 21% in real terms since 2004/05 when the new GMS contract enabled GPs to opt out of the service.
Services were being made even more unsustainable by health boards boosting pay for last minute shifts or to compete with neighbouring areas, the WAO report said.
And new rules around tax and employment could further deter staff from choosing to work in out of hours if not resolved, it found.
The WAO called on the Welsh government to work with health boards to address the factors that were causing poor morale and staff shortages.
There should also be a regular national assessment of quality of out of hours services, it recommended.
Around 0.6 million in Wales contact out of hours every year and problems with the service were first highlighted in a ministerial review in 2012 which concluded services were unsustainable.
A previous WAO report published five years ago warned of issues with recruitment and retention of GP and national standards for out of hours services were first agreed in 2014
The Board of Community Health Councils warned the service was fragile earlier this year.
A national NHS 111 service is now being rolled out after being piloted in two areas, but the WAO report said this move would not solve all the problems being faced by out of hours and some plans and timescales including that for IT needed clarification.
Dr Rebecca Payne, RCGP Wales chair, said the findings were concerning although not surprising.
‘Out of hours services are unsustainable in their current form.
‘GPs and other staff are being asked to work in a difficult environment and patients can’t always access the services they need in a timely fashion.’
She added: ‘Secondary care dominated health boards now run out of hours in most parts of Wales and they have neglected their primary care responsibilities.
‘At times of pressure help and support is given to A&E, but out of hours all too often is left unsupported, under resourced and – despite the dedication and commitment of staff working in the service – unable to compensate for these wider system failures.”
Dr Payne called for more call handlers, better use of other healthcare professionals and technology, and employment conditions that protect staff working in a high-risk environment.
A Welsh Government spokesperson said: ‘The report recognises that patients are generally happy with the out of hours primary care service they receive. However, we are aware of the strains the service can face and action is already underway to address the majority of recommendations made in the report.’