At least 4 million people were left without access to an out-of-hours doctor at some point last year because of inadequate staff cover and pressure on resources, it has been revealed.
The figures, which have raised alarm about patient safety in the NHS, were obtained by the GP’s magazine Pulse in a freedom of information request to 104 out-of-hours commissioners of care.
Ten of the providers, covering about 4 million people, admitted that on some occasions last year shifts had been left unfilled, leaving patients with no out-of-hours cover.
In the areas hit, patients were told to go to A&E, while services had to rely on non-medically qualified urgent health practitioners, or nurses and paramedics.
Pulse identified five of the areas worst hit in 2016 as:
- Peterborough, where there were nine shifts and 230,000 patients were left without access to an out-of-hours GP. All children under the age of four were “defaulted” to A&E, the magazine said.
- Tower Hamlets, east London, where no GP was available on 12 occasions. This meant a population of more than 250,000 was told to contact A&E or the “community night team”.
- Doncaster, where nurses and paramedics had to cover a population of 300,000 patients on three occasions, with no GP available by phone on one occasion.
- The Highlands, which has a population of 340,000, where there were 31 times when out-of-hours centres were closed due to lack of staff. Shifts there had to be covered by centres up to a 30-minute drive away.
- In southern and western Northern Ireland, the survey found that one GP regularly had to cover 370,000 patients overnight.
Many of the doctors in those areas spoke of their concern for the safety of patients.
Dr Frances O’Hagan, who works for the out-of-hours service in southern and western Northern Ireland told Pulse the system was “broken”. She added: “Having only one doctor on call used to be rare but is becoming the norm.”
Dr Dean Eggitt, medical secretary for Doncaste’sr local medical committee, said “the system is not safe”. He added: “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.”
Dr Alan Woodall, an out-of-hours GP in England and a GP partner in Wales, told Pulse: “The pressures on the out-of-hours service are approaching critical.
“I cover an area that stretches 800 sq miles on the evening shift because there is nobody else. It only takes two sick people at either end of the patch to result in doctors having to be pulled in from other patches, leaving their area uncovered. We are constantly trying to firefight demand.
“Because of the rota gaps and pressure on resources, we will have to employ a lot of urgent care practitioners and paramedics to help us cope.”
Other GPs told Pulse high insurance costs were a factor in why doctors turned down shifts.
Dr Emma Rowley-Conwy, who works in south-east London, said: “Indemnity is a deterrent as it costs about 10 an hour to get insurance from a defence organisation.”
The Royal College of GPs urged the government to do more to make out-of-hours working more attractive to family doctors.
Prof Helen Stokes-Lampard, chair of the organisation, said more GPs were needed to tackle a national shortage, but the high cost of insurance was also to blame.
She said patients should be able to access GPs when they need it, and that it “very concerning” that this was not always the case.
Stokes-Lampard said the Pulse report “hammers home how important it is for the government to make good on its promise to deliver 5,000 more extra GPs by 2020”.
Ruth Rankine, deputy chief inspector of general practice at the Care Quality Commission, said
“If we find on our inspections that staffing levels are leading to patients receiving unsafe care and treatment, including delays in response times, then we have a range of enforcement powers we can use to ensure that appropriate action is taken.”
Doctors shortage left 4 million patients without cover last year
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