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Up to a quarter of GP out-of-hours shifts left unfilled

Exclusive A quarter of GP out-of-hours shifts are going unfilled in some parts of the country, leaving gaping holes in on-call cover as providers struggle to find staff, a Pulse investigation reveals.

Commissioning, extended opening and tax changes have drained the system of GPs willing to work out of hours, with some providers admitting they are turning to nurses to avoid holes in rotas. GPs across more than 20 different parts of the UK – including Yorkshire,

Devon, Hampshire, Merseyside and south-east London – reported local out-of-hours providers were leaving gaps in rotas.

And there was evidence of a severe shortage of on-call doctors for shifts across the east of England, which in the wake of the Ubani case stipulated only GPs on local performers lists could work out of hours.

In Suffolk, the proportion of unfilled shifts at the out-of-hours service run by Harmoni was 25% last June, and has not fallen below 13% since the introduction of the new policy.

NHS Great Yarmouth and Waveney reported 29% of shifts were partially or totally unfilled last September, although the situation has since improved, while NHS North Essex cluster said up to 5% of slots had been unfilled since March.

Among 250 GPs responding to a Pulse survey, almost half reported their local out-of-hours provider was struggling to

fill shifts, while one in four reported gaps in rotas. Almost one GP in 10 said they had felt compelled to start working out-of-hours shifts again as a result of the local staff shortages.

Andrew Gardner, chief executive of Harmoni, said: ‘The key to providing first-class out-of-hours services is assessing whether the demand of patients is being met through good overall performance against national standards, not through the number of unfilled vacancies.'

But Dr Simon Poole, a GP in Histon, Cambridgeshire, and deputy chair of the GPC's commissioning and service development sub-committee, said: ‘If doctors are absent, you have to be concerned about safety. One measure of an out-of-hours provider's success should be the capacity to recruit local doctors.'

Dr Judy Davis, a GP in Cambridge who works fewer out-of-hours shifts than in the past, said: ‘The pay is quite poor, plus with the 50% tax rate it is not economic for a lot of experienced doctors.'

PCTs and providers contacted by Pulse denied patient care had been affected, with several areas – including Great Yarmouth and Waveney, Devon and North Yorkshire – claiming there were no significant gaps on rotas.

But some acknowledged recruitment was a problem. Dr Atul Kumar-Beurg, clinical director of primary care services at Solent NHS Trust, said: ‘It is not correct to say we are having difficulties filling shifts. However, the number of local GPs coming forward to work out of hours has diminished. So we're making use of skill mix.'

Henry Clay, a director of the Primary Care Foundation, which is soon to publish its latest benchmark of out-of-hours providers, warned failure to recruit GPs to work out of hours was a ‘vicious circle': ‘If a GP is left holding the baby, they start to think, 'I'm being put in an impossible situation.'

Six of 14 trusts contacted by Pulse were unable to say how many shifts went unfilled – a finding Mr Clay said raised questions over their monitoring. 

Out-of-hours gaps

29% Shifts totally or partially unfilled at NHS Great Yarmouth and Waveney last September

25% Proportion of GPs telling Pulse's survey their out-of-hours provider was leaving gaps in rotas