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One in ten areas left without GP out-of-hours cover

Exclusive Out-of-hours GP services are on a knife edge, with providers covering some four million patients admitting they have had overnight and weekend shifts over the past year with no GP cover, finds a Pulse investigation.

Some 104 lead out-of-hours commissioners across the UK responded to Pulse’s request under the Freedom of Information Act, with 10 saying there were occasions where patients were left with no GP available during out-of-hours shifts in 2016 due to chronic shortages of staff.

GP out-of-hours leaders say this is part of a ‘worrying trend’, with fewer clinicians available and services often relying on non-medically qualified urgent health practitioners, nurses and paramedics.

In Peterborough, there were nine shifts where 230,000 patients were left without access to an out-of-hours GP and all children under the age of four were ‘defaulted’ to A&E. Tower Hamlets, east London, had no GP available on 12 occasions last year. This meant a population of more than 250,000 was told to contact A&E or the ‘community night team’ for help.

In Doncaster, a lack of GPs meant nurses and upskilled paramedics were covering a population of 300,000 patients on three occasions, with no GP even available by phone on one occasion. Doncaster LMC medical secretary Dr Dean Eggitt said ‘the system is not safe’, adding: ‘I think 24 hours a day patients should be able to contact a senior clinician, a GP. If that is not available that is a very serious situation that must be remedied ASAP.’

National quality standards say patients should be able can access a GP face to face if ‘clinically appropriate’. In 2012, private out-of-hours provider Serco found itself in the headlines after a whistleblower revealed the company only had one GP covering a population of 500,000 people in Cornwall.

This led to a huge controversy, with the provider being removed and an investigation by Government auditors finding 60% of providers ran shifts without the optimum staffing levels. But, the Pulse investigation suggests staffing problems are worsening.

Out-of-hours providers admit that staff shortages have forced some providers to shut down provision, piling pressure on other services, such as GP practices and A&E departments. Dr Simon Abrams is a GP in Everton and chair of Urgent Health UK – the representative group for out-of-hours GP providers – said: ‘It is a worrying trend. It can be a last-minute appointment that keeps the service afloat, especially at weekends.

‘Additional funding can be required to attract takers and even then there are occasions when rotas are not full. Then, closing urgent care centres or staggering opening times is the only option. This probably impacts more on rural communities where patients are already travelling several miles to see a GP out of hours.’ He added: ‘Erosion of these services not only raises clinical risk in the community but adds to pressure on A&E.’

The CQC – which polices the safety of out-of-hours services in England – says it will ‘review’ the results of Pulse’s investigation. A spokesperson said: ‘We want to be confident these providers are monitoring their services effectively so patients receive safe care at all times.’