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Low morale among GPs leaving Welsh out-of-hours posts unfilled, finds report

Out-of-hours (OOH) services in Wales are increasingly under strain, partly due to low morale among GPs, according to a new report.

A report on primary care OOH services, released today by the Welsh Public Accounts Committee (PAC), found that there was a ‘vicious circle’ of GPs refusing to take on OOH shifts over concerns about working alone and growing pressure caused by unfilled posts. 

Pulse reported in May that an out-of-hours service in west Wales had no GP cover 125 times during 2018, with the total number of shifts with no GP available rising from 57 in 2017 to 146 last year.

The PAC heard evidence that OOH services across Wales are faced with increasing challenges, including low morale, a lack of GPs and unattractive pay, adding that even financial incentives to attract GPs have failed as they do not want to work alone. 

The report stated: ‘The committee is extremely concerned that there are enduring issues which are making out-of-hours services unattractive places to work. Staff morale within out-of-hours services is a challenge given the strong evidence heard that improving staff morale has little to do with offering financial incentives.

‘Instead it is clear to us that the working environment has a greater impact on morale due to concerns about lone working, working under pressure due to unfilled shifts and not feeling part of a valued team. In rural areas these issues are magnified as GPs find themselves alone covering vast geographical areas and faced with difficult logistical decisions in terms prioritising patients.’

It gave the example of Hywel Dda University Health Board (HDUHB), where there were 99 base closures within the OOH services since May 2017. 

The report said: ‘One of the biggest issues of morale for the health board [HDUHB] is that there is quite a “vicious circle”, once staff know that not all the shifts are going to be covered they do not want to take up a shift and know they are going to be working on a shift under heightened pressure.’

The report added there had been issues with pay inequalities across health boards, which was creating a competitive market. 

It said: ‘We have heard concerns about differences in pay arrangements between health boards which is leading to competition for GPs between geographical areas. This has led to problems in filling out-of-hours shifts in some areas.’  

The report recommended that the Welsh Government address these pay inequalities and: 

  • Share best practice to make out-of-hours services more attractive places to work,
  • Develop policies to increase GP numbers,
  • Review the way funding is allocated to health boards for OOH services to ensure it reflects the current needs. 

BMA’s Welsh GPC former chair Dr Charlotte Jones said: ‘BMA Cymru Wales has repeatedly warned of the growing gap between the demand placed upon general practice and its capacity. Years of underinvestment, along with rising workload has meant that GPs in Wales are increasingly being asked to do more with less, and out-of-hours care has suffered some of the worst effects.

‘We are inundated with stories from our members citing issues with shift filling and trouble across a wide geographical area in out-of-hours coverage, with one member speaking of as little as one nurse practitioner left in charge across two hospitals covering around 280,000 patients. To help combat this we would urge the Welsh Government to support the further development of multidisciplinary teams, but not as a replacement for doctors.’

The report will now be considered by the Welsh Government, according to the Welsh Assembly. 

Earlier this year the BMA declared GP staffing for out-of-hours services in north and west Wales had reached ‘crisis point’ after it emerged that Hywel Dda University Health Board has suspended its services on several weekends due to GP shortages.