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Wales out-of-hours services at ‘crisis point’ as providers unable to cover weekends



Out of hours GP services across Wales are struggling and in north and west Wales the shortage of out of hours GP has reached ‘crisis point’, the BMA has warned.

It has emerged that out-of-hours services in West Wales are being suspended at the weekend due to GP shortages.

The Hywel Dda University Health Board said that out of hours services at Withybush General Hospital in Pembrokeshire and Prince Philip Hospital in Carmathenshire were not able to remain open on the weekend of 30/31 March.

The board also said that there were gaps in the rotas in the weekend just gone.

Dr Peter Horvath-Howard, deputy chair of the BMA’s GPC Wales, said action is urgently required to provide a safely staffed service.

‘While shortages within out-of-hours GP services are reaching crisis point in north and west Wales, it is a major problem across Wales,’ he said.

He added: ‘The workload of GPs is already overstretched in-hours, with many feeling overworked and unsupported. This means that the number of GPs prepared to regularly work additional hours to cover OOH services has decreased. There’s also a low degree of confidence in safety systems.’

A Welsh Government spokesperson responded by saying that GP recruitment was a problem across the UK: ‘Work is being undertaken by clinical leaders to encourage GPs to work in out of hours by making it a more attractive place to work.’

The spokesperson added: ‘The new delivery model for the out of hours service is increasing based around multi-disciplinary team working, that are less reliant on GPs to deliver the activity but place greater emphasis on their clinical leadership role.’

A statement on the Hywel Dda University Health Board’s website last week read: ‘We are again experiencing a shortage of GPs to cover the Out of Hours service in Carmarthenshire and Pembrokeshire this weekend. Efforts are continuing until the last possible moment to fill the shifts affected, however there are still gaps in the rota affecting service provision between Saturday and Sunday.’

Out of hours care has been closed at Withybush from 5pm-7pm on Sunday while Prince Philip’s service has been closed from 7pm Saturday to 8am Sunday and 6pm to 11pm on Sunday. The health board advised patients needing GP assistance at these times should call 111 instead.’

Joe Teape, deputy chief executive and director of operations at Hywel Dda University Health Board, said: ‘I’d like to apologise again for any concern or inconvenience caused to residents. Unfortunately we are continuing to experience GP shortages from time to time and we appreciate the efforts our staff, GPs and partners from across the Hywel Dda area are making to ensure we can provide safe services for our patients.’

RCGP Wales joint chair Dr Peter Saul said: ‘The out-of-hours GP service across Wales is under considerable pressure and strain. It is, of course, staffed by the same doctors who are working during the day. This service has a vital role to play in providing excellent patient care and reducing unnecessary accident & emergency attendance.’

Dr Saul noted that a 2018 study from the Board of Community Health Councils had revealed that every health board identified fragility in their out-of-hours services. ‘In response, we have set out a clear and achievable strategy which could be adopted to improve the sustainability of out-of-hours GP services.’ The core challenge was to get the Welsh Government to prioritise GP recruitment and training, he said.

In 2017 a Pulse investigation found that one in 10 providers across the UK admitted to periods with no overnight GP cover, a situation affecting four million people. http://www.pulsetoday.co.uk/your-practice/practice-topics/out-of-hours/revealed-why-out-of-hours-is-on-a-knife-edge/20033775.article

The following year a Pulse survey found a 26% increase across the UK in the number of incidents reported by GP out-of-hours services to commissioners in 2017. http://www.pulsetoday.co.uk/news/commissioning/commissioning-topics/urgent-care/pressurised-gp-out-of-hours-see-serious-incidents-increase-by-26-in-a-year/20035953.article