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Out-of-hours service had no GP on shift 125 times in a year



Exclusive An out-of-hours service in west Wales had no GP cover 125 times during 2018, the findings of a Pulse investigation have revealed.

The service, commissioned by Hywel Dda University Health Board, saw the number of occassions without a GP almost triple in the space of a year – in 2017, there were 42 times.

The investigation, which looked at OOH services across the UK, found there were six regions in total – including three in Wales – that operated without GPs on shift in 2018 (see table, below).

The total number of shifts with no GP available rose from 57 in 2017 to 146 last year, according to the findings, based on reponses from 79 CCGs and health boards to freedom of information (FOI) requests.

GPs said the national staffing shortage was to blame, while warning the potential safety risks now associated with stretched OOH services meant GPs were often no longer willing to work for them.

Hywel Dda University Health Board’s deputy chief executive Joe Teape said: ‘This is a familiar trend among health boards and we are working together across different services to offer access to out-of-hours care.

‘Advanced nurse practitioners support OOH activity in parts of the area and the service has collaborated with the Welsh Ambulance Service to introduce advanced paramedics to support GPs.’

Meanwhile, Pulse’s investigation uncovered the number of serious incidents recorded by OOH providers has risen by more than a quarter in the space of a year.

Data provided by 109 CCGs and health boards across the UK to FOI requests show 108 serious incidents were reported across 44 CCGs in 2018, against 84 serious incidents in 2017.

Dr Alan Woodall, chair of GP Survival and a GP in Montgomery, said staffing problems and lower rates of pay were leading to shifts with no GPs.

He said: ‘Wales, in general, pays GPs poorly in terms of out-of-hours rates, and given locums are in demand and can earn more in the day for less risky work, people are no longer willing to do it.’

Liverpool GP Dr Simon Abrams, chair of Urgent Health UK, which represents out-of-hours providers said: ‘We’re in a national recruitment crisis. If you’ve got a day job there’s a lot of pressure that makes being available to do out-of-hours even less likely than it used to be.’

However, he said the increase in the number of serious incidents may reflect a greater willingness to report problems.

He added: ‘We’ve become more safety conscious. At Urgent Health UK, we encourage colleagues to bring serious incidents so the learning can be spread out.’

Dr Charlotte Jones, BMA GP Committee Wales chair, said: ‘These figures are unsurprising and confirm what we have been saying for some time: that many out-of-hours services throughout Wales – but in west Wales in particular, have evidenced services that are at breaking point and some are clearly in crisis.

‘We know that the workload of GPs in hours has increased substantially meaning many are overstretched and too exhausted or finishing their days too late to also provide cover in evenings and weekends.’

She added: ‘We have repeatedly put forward a range of solutions to the Welsh Government and health boards including tailoring offers to the needs and wants of individual GPs along with some solutions that would need national action.

‘GPC Wales believe that these solutions need to be urgently implemented together with additional mechanisms to ensure the workforce is valued and working in supportive safe organisations so that they can build a safe sustainable out-of-hours service for Welsh patients that is fit for purpose’.

Last month 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.

A previous Pulse investigation found that one in 10 providers across the UK admitted to periods with no overnight or weekend GP cover in 2016, a situation affecting four million people.