Scotland facing summer out-of-hours GP crisis

Alan McDevitt, BMA Scottish GPs committee chairman. Picture: Contributed

Alan McDevitt, BMA Scottish GPs committee chairman. Picture: Contributed

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DOCTORS are warning of a summer NHS crisis over a failure to find enough GPs to treat patients in the evening or at weekends.

A Scotland on Sunday investigation has found that most NHS boards are still to fill slots for out-of-hours cover this coming month, with some having to rely upon private doctors, nurses and paramedics to ensure some kind of coverage for patients.

Health boards and GPs both are warning that the crisis is particularly acute this summer, with doctors on holiday and amid evidence that large numbers of those still at work are no longer willing to fill the after-working-hours posts because of decade-old rates of pay and rising stress levels.

The British Medical Association is now in talks with the Scottish Government to avert a “crisis point”. The lack of cover has implications for hospitals as it could potentially force patients to go to A&E units during the weekend or at night for minor complaints if they want to be seen promptly.

In Greater Glasgow, the country’s largest health board area, health chiefs have been forced to advertise across Britain and have approached private GP agencies for staff as it seeks to fill a “particularly” difficult period.

Grampian Health Board said that in June one in five of its own out-of-hours shifts were covered by nurse practitioners or ambulance staff, while 17 per cent were left unfilled.

In NHS Highland, one in five out-of-hours shifts are still to be filled for July.

The emerging problem has roots in changes to the contract on which GPs are employed. Since 2004, medical practices can now choose whether or not to provide out-of-hours services for their patients. The vast majority decided not to do so, with responsibility for providing cover moving to health boards.

An Audit Scotland report warned five years ago that there was a “risk” that, as the new contract continued, many GPs would opt against providing the care, as is their right.

Doctors leaders said last night that the problem was now “coming to a head”. Dr Alan McDevitt, chair of the British Medical Association’s Scottish GPs committee, said that older doctors were no longer opting to work out of hours because of recent increases to pensions contributions, which was lowering take-home pay.

“So, you are working for a lot less money and it is stressful work, so a lot of them moving towards the end of their career are just deciding that it is not worth doing the extra work at that stage,” he said. “Also the pay rate has largely not changed since 2004, so gradually that makes people less attracted to doing it.”

He said that with out-of-hours attendances having ­increased by 11 per cent in some areas over the past two years, GPs were too exhausted to work after hours, as well as during the working week.

“The job is getting busier. Quite often the GPs working in it don’t feel they are properly supported and they are working under extreme pressure and high volume,” he said. “In a lot of areas we believe the number of doctors doing it have been reduced, so the health boards are not employing the same number of GPs to do it, so fewer doctors doing more patients is the impression that we have.”

BMA leaders were now in talks with the Scottish Government to avert a crisis, McDevitt added. “It’s important that the public has confidence in GP out-of-hours services, and we think that by taking strong action now with the Scottish Government, we hope to avoid any problems with public confidence.”

A spokeswoman for Greater Glasgow Health Board said it intended to ensure slots were fully staffed in July. However, she said: “Despite the ongoing support of local GPs, the ­holiday season presents challenges in staffing the service and this is particularly so this year.”

An NHS Highland spokeswoman said that of 276 shifts needing to be filled in July, 57 were still empty. The health board said that the use of “unscheduled care practitioners, nurses or paramedic practitioners” was being considered.

Meanwhile, NHS Grampian said that, in June, only 61 per cent of the GP out-of-hours service was covered by GPs, with 22 per cent by nurses and paramedics, and 17 per cent unfilled. A spokeswoman said that it expected the “majority” of shifts to be filled in July but, depending on circumstances, patients could be “offered telephone advice and asked to come to their nearest centre or receive a home visit”.

NHS Forth Valley said that a quarter of out-of-hours shifts in the Falkirk, Stirling and Clackmannanshire area over the coming three weeks remained to be filled. “We anticipate that these will be allocated over the next few weeks.”

NHS Ayrshire and Arran said that 91 per cent of its July rota had been filled and that it was “confident” of filling all slots.

NHS Lothian said that 98 per cent of its July shifts were filled. It said no locums or overseas GPs had been recruited.

NHS Fife said that of 408 shifts, 19 were still to be filled.

NHS Tayside said that 92 per cent of its shifts for July had been filled. A spokesman said: “We continue to work actively on our rotas, keeping them under review and trying to fill any vacant shifts right up to the day.

NHS Orkney said that 100 per cent of its slots were filled, the only board to offer that guarantee. NHS Lanarkshire did not supply figures, but said it was “confident” that “continuity of services” could be provided this month.

NHS Western Isles, Shetland, Borders and Dumfries and Galloway failed to reply.

Margaret Watt, chair of the Scotland Patients Association, said: “The Scottish Government needs to work much more closely with doctors so we don’t get these situations. We don’t want this to reach a crisis point in out-of-hours care.”

A Scottish Government spokeswoman said: “NHS boards are responsible for effective, safe care throughout the entire year.

“At times of particular demand, including the holiday season, the standard approach is that NHS boards utilise all necessary mechanisms to ensure they are staffed to provide a service that can meet demand and best support the patients in their area.”

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