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GP out-of-hours standards not being met

Welsh out-of-hours services under serious strain

Adrian O'Dowd

Thursday, 12 July 2018

National standards for GP out-of-hours services in Wales are not being met as the service is under significant strain, according to the public spending watchdog for Wales.

The Wales Audit Office (WAO) has today published a report Primary Care Out-of-Hours Services which says that although patients seem generally happy with services, there are various problem including poor staff morale and difficulties in filling shifts that are threatening the resilience of services in many parts of Wales.

The WAO report found that national standards on the timeliness of appointments were not being met and that patients needed to be given better information about how to access services.

There was also a lack of information on service quality and performance which was hampering effective management of services at national and local level.

Planning of out-of-hours services usually happened in isolation from other services despite it being part of a wider urgent care system, said the authors, who also warned that while the new 111 telephone service due to be rolled out throughout Wales would help address some integration issues, it would not solve all the problems.

“Health boards’ spending on out-of-hours services varies widely, and across Wales as a whole, Welsh government’s national funding for out-of-hours has fallen 21% in real terms since 2004-05,” says the report.

“Services are taking unsustainable approaches to paying GPs, such as increasing pay rates for last minute shifts, and by increasing rates to compete with neighbouring health boards.”

The report makes various recommendations including:

  • standardising patient information on NHS websites and GP phone lines
  • doing more to make out-of-hours services more attractive places to work
  • developing a national workforce plan to tackle staffing problems.
Auditor general Huw Vaughan-Thomas said: “This report highlights the urgent need to strengthen out-of-hours services and address some long standing workforce challenges.

“Patients also need better information on how to access services. It is essential that the Welsh government and health boards work together to implement my recommendations and develop sustainable improvements to these vital services.”

Dr Rebecca Payne, RCGP Wales chair, said: “The findings of the report are concerning. Out-of-hours services are unsustainable in their current form. GPs and other staff are being asked to work in a difficult environment and patients can’t always access the services they need in a timely fashion.

“Secondary care dominated health boards now run out-of-hours in most parts of Wales and they have neglected their primary care responsibilities. At times of pressure, help and support is given to A&E, but out-of-hours all too often is left unsupported, under resourced and - despite the dedication and commitment of staff working in the service - unable to compensate for these wider system failures. Addressing this needs leadership from Welsh government and from health boards.”

Dr Charlotte Jones, chair of the BMA’s GP committee in Wales said: “BMA Cymru Wales has real concerns about the sustainability of out-of-hours services across Wales and have been highlighting this for some time.

“Having safe and sustainable out-of-hours services for patients is highly important and BMA Cymru Wales has put forward a range of solutions to the government and health boards to ensure safe and sustainable services for staff and patients.”

A Welsh government spokesperson said: “The report recognises that patients are generally happy with the out-of-hours primary care service they receive. However, we are aware of the strains the service can face and action is already underway to address the majority of recommendations made in the report.”

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