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OOH provider ‘diversifying’ its workforce away from GPs

OOH provider ‘diversifying’ its workforce away from GPs

An out-of-hours (OOH) provider is ‘diversifying’ its workforce due to financial constraints, leaving GPs struggling to find shifts. 

Cambridgeshire GPs have been warned by their local OOH provider that their shifts may be ‘cancelled or moved to adjust the resource’, according to an LMC update last month.

HUC, an OOH provider across Cambridgeshire, Peterborough and Hertfordshire, told Pulse that a reduction in available locum shifts has led to their OOH GP shifts becoming ‘heavily oversubscribed’. 

The provider also said it has ‘sought to diversify its workforce’ due to financial pressures, and this is ‘in line with’ other OOH providers. 

Recent reports have indicated a scarcity of work among locum GPs – a Pulse survey in November revealed that around half of locums have seen a decrease in their sessions worked over the past year due to lack of available work. 

And last month, the BMA’s GP Committee in England chair Dr Katie Bramall-Stainer told Pulse that general practice has gone from a recruitment to an employment crisis, and that ‘squeezed’ funding meant practices are ‘forced’ into using ARRS roles.

Cambridgeshire LMC told its members: ‘Locally, GPs taking up OOH shifts have this week been advised that HUC are “reviewing rota patterns…you may have some of your shifts cancelled or moved to adjust the resource”.’

It went on to encourage affected GPs to contact their local BMA office, as they may be liable to pay ‘outstanding monies’ if they give less than four weeks’ notice when cancelling or moving other shifts as a result. 

The LMC newsletter also referenced the BMA practice finance survey, which last month revealed an average 20% drop in GP contractor income.

‘We know that this is likely the other factor behind GP under-employment, alongside ARRS. We also know that HUC are looking to diversify their workforce too, and bring in greater numbers of wider roles such as PAs, supervised by GPs,’ the local leaders said. 

They urged practices to consider the ‘longer term consequences’ of choosing other roles over employing more GPs.

In response, a spokesperson for HUC said: ‘As the BMA has acknowledged, tight finances and pressure on practices to use additional roles staff have caused a “huge reduction in available locum shifts”.

‘Consequently, GPs have been turning to out-of-hours to pick up shifts, as a result of which HUC’s out-of-hours GP shifts have become heavily oversubscribed. 

‘At the same time, in line with other out-of-hours providers, HUC has sought to diversify its workforce in order to provide the best-possible care for patients given the financial constraints within which it operates.’

However, HUC denied the LMC’s claim that they are looking to bring in physician associates, saying they have ‘no plans to introduce the PA role’ and remain ‘fully committed’ to using GPs and encouraging requests for salaried roles. 

GPs in other areas told Pulse that while their extended hours or OOH teams are not being ‘diversified’ with other roles at the moment, the service is certainly becoming more popular as locum work becomes scarce. 

Dr Farzana Hussain, who works extended hours shifts with her GP federation in East London, said using more multidisciplinary teams is ‘definitely the direction of travel’ and that ‘ICBs would want that’. 

She said: ‘I’m very fortunate that at my federation, it’s not that we don’t have a multidisciplinary team – we do have some pharmacists working with us, and obviously practice nurses and HCAs – but it is still quite GP-led.

‘And I personally think that’s obviously a good thing for safety as well. So our federation, I think mindfully, hasn’t [moved towards using other professionals]. 

‘But I am concerned that they will have to in future because obviously the budgets are so low – will they be able to afford the doctors? A bit like the practices have had issues with paying the locum rates, having the physician associate or a pharmacist who are obviously much cheaper, but do a different job.’

Dr Selvaseelan Selvarajah, who works OOH shifts in Hackney, told Pulse that his service only uses GPs but that larger providers are more likely to use a multi-professional workforce. 

He said it has ‘certainly been easier in the last couple of months to fill the shifts’ compared to previous months when it was ‘always a struggle’. 

‘I also run a 111 hub and acute respiratory hub – again GP-led and it has been incredibly easy to fill shifts within days because there’s clearly a lot of GPs looking for work and are willing to take it up when it becomes available. So our shifts are booked at least two to three months in advance,’ Dr Selvarajah added. 

He said the main reason for this is that practices do not have enough funding and are having to ‘tighten their belts’ and use locums ‘much less’. 

‘Some practices, certainly not ours, but I know of practices who have used allied health professionals to fill in the rota gaps rather than replacing them with GPs,’ he said. 

Meanwhile, chair of Urgent Health UK Dr Simon Abrams told Pulse last month that many of his providers are finding it easier to fill their rotas as more GPs are looking for OOH shifts. 

He said this is in contrast to the last 20 years during which it has consistently been very hard to fill shifts.



Please note, only GPs are permitted to add comments to articles

Scottish GP 22 February, 2024 12:12 pm

Anyone any idea why the hospital is full now?…….

Michael Johnson 22 February, 2024 12:48 pm

Never mind the quality. Feel the cheapness!!!

Im not sure why any of us trained for years to be GP’s , kept up to date and operated at expert level when any bugger it seems can do our job

Fay Wilson 22 February, 2024 12:56 pm

OOHOs with tight funding and GP shortages have had to diversify their workforce over the last 10-15 years in response to austerity commissioning. Many have introduced ANPs and other ACPs. Evolution is always easier than revolution and adaptation to a financially skinny climate takes time and patience. Who governs HUC? Do local GPs have any influence? Is this ICB in deficit and do local GPs have any influence on the ICB’s funding priorities?

RAj muvva 22 February, 2024 1:19 pm

In our local area , OOH was largely run by ANP’s with one or 2 doctors covering a population of around 370000.The house calls waiting upto 24 hrs and sometimes patients ending up in hospital. The health board claims that they keep doing comfort calls to patients waiting for the visit. As a result the health board grossly underspent on their budgets.. win win for them.

John Graham Munro 22 February, 2024 1:30 pm

@ Michael Johnson———as I’ve been saying since the year dot ”you do not have to train to be a G.P.-”——-I never did——-and I’ve been putting F.R.C.G.P. after my name, just like Jamie Oliver

So the bird flew away 22 February, 2024 5:11 pm

“Diversifying”? In the sense that members of the Cabinet are soon gonna find their roles “diversified” away to a bunch of Labour MPs…

Some Bloke 22 February, 2024 6:19 pm

and we all should be diversifying our work away from NHS

David Banner 23 February, 2024 8:40 am

We probably shouldn’t complain too loudly about this. A simple solution for any government would be to reverse the 2004 contract change and dump OOH responsibility back on to Practices.
(When PCNs were formed this threat was buried in the small print, remember)
A few years ago the headlines were “no doctors available” for OOH (eg Wales famously had 1 GP covering the whole country), so obviously OOH providers were going to “diversify”, and now the money’s dried up they’re rapidly moving to cheaper staff, just like Partnerships have done.
If the service is deemed dangerous or inadequate, the temptation to push OOH on to PCNs could prove irresistible to government. Ironically we would probably have to staff it with ARRS!!!!!

Turn out The Lights 23 February, 2024 8:47 am

When does the race for the Bottom stop getting quicker.When will the bottom be hit.Roll on April.

Finola ONeill 23 February, 2024 10:11 am

Don’t worry David Banner. If OOH gets dumped back on General Practice the patients can still see the same non doctors that theu now see in their GP surgery in hours and send them all to A&E just the same. I work in A&E every weekend seeing the guff sent in by 111 call handlers and non doctors, some also seen by GPs that are either very risk averse or don’t have much clinical skill to assess by history and examination. Helps with the GP and 111 overload hitting that A&E. I see 20-25% of the entire daily GP attendances on the weekend at the largest A&E in the county. One patient every 10-15 minutes. It’s a revelation to the staff their re our speed and ability to assess clinically without scanning everyone and doing bloods and investigations on everyone that walks in the door. I told them. That’s what GPs do. We can all move to A&E to deal with the deluge sent in by the non doctor staff now seeing them. Muscial chairs. What fun.

Finola ONeill 23 February, 2024 10:19 am

I say transparency is key and patients can take it up with the politicians.
I have a petition; name badges and mandatory professional obligation to introduce role in all consultations (in person and phone) and communications and name badges plus change “physician associate” name to “doctor assistant”.
Most of the change is being assoisted by deliberate obfuscation by the govt and NHSE as to the “diversification”, ie dismantling; of General Practice and NHS services.
Feel free to read and sign:

Centreground Centreground 23 February, 2024 11:19 am

This has been happening gradually for years across the country and now accelerating with PCNs.
In many case these have become nothing more than poorly regulated ‘Out of Hours Fobbing Off Services’ in my opinion.

Dylan Summers 23 February, 2024 1:27 pm

@Centreground Centreground

“Out of Hours Fobbing Off Service” is inherent in the service design. Since even before the contract change in 2014, most GPs were in co-operatives where the OOH clinician would not necessarily be one of the GPs with long-term clinical responsibility. The understanding was that anything that could wait should wait; and any long term plans should be made by the patients’ long-term clinicians IE the usual GPs.

Now many of us are becoming used to a world where other clinicians (EG from a PCN extended-access clinic) make long term plans for “our” patients. So maybe OOH should be more like this. But funding would need to increase to allow OOH to take on this work.

Dylan Summers 23 February, 2024 1:31 pm

2004 I mean, not 2014!

Truth Finder 23 February, 2024 2:54 pm

Just had 111 call for tonsillitis. Very poor confusing history taken, fobbing off to the GP to be seen within 6h. We don’t need an expensive receptionist adding to the workload.

Zack Magkrachi 24 February, 2024 1:40 pm

Some providers have started listing shifts for GP OR ANP! Of course ANPs will take priority over GPs as they cost less even though they are amazing at their work, but to equate the two !? There is a concerted effort here to replace us and a complete lack of respect for our skills. God help our patients.

Bernie Hunt 24 February, 2024 2:06 pm

111 last are also reducing GP use.
When my call paperwork is sent to a GP, he doesn’t know a GP has triaged. He has to read all the rubbish produced by a call handler, that’s gobbledygook, even to me who works in system, and then get to p/c.
If anp/ paramedic/ nurse speak with PT, they don’t take a medical history, they don’t ask open questions as they wouldn’t know what to do with the answers. Patients get triaged on what they first told call handler. Ie sinusitis diagnosed for 2 hrs jaw pain, and PT dies in GP waiting room, in London last year.
Clearly having lower skilled staff triaging is the problem. Hence why 111 triage history isn’t worth paper it’s on. But if you knew a Dr wrote it, you might find it valuable.
My doctor title is stolen at 111, it’s part of NHSE plan for deprofessionalization of doctors, ‘ the way forward’. Cheap, substitutes who when they recognise extent of knowledge send many PTS to a&e to be safe, a safe anp/ ACP/ paramedic. Good for PT quality but not A&E service, especially when that’s now filling up with limited knowledge acps. More scanners needed I’d say. Who needs medical knowledge when you can take pictures albeit ‘ right bit needs to be identified’ by ACP.

A B 25 February, 2024 2:16 pm

This story is not in mainstream newspapers. Why not? Over the course of my lifetime the country I was born in has turned into a place I do not recognise and don’t want to be. I know many people feel the same. If you don’t understand where I’m coming from, its likely you are part of the reason the country is now such a shit hole. Congratulations …expect more of the same