Out-of-hours services still unattractive to many GPs
Author: Adrian O'Dowd
Too many GPs still view working for out-of-hours (OOH) services as an unattractive option with high pressure and low morale, according to politicians in Wales.
Members on the National Assembly's public accounts committee have published a new report* about OOH services, saying they were concerned at how unattractive these services were to clinicians who cited lone working, working under pressure due to unfilled shifts and not feeling part of a valued team as reasons for low morale.
In rural areas, the issues were magnified with GPs covering large geographical areas and faced with difficult logistical decisions in terms of prioritising patients and often alone.
During its inquiry, the committee learned about innovative schemes operated by Cardiff and Vale University Health Board and Hywel Dda University Health Board.
Cardiff and Vale supports OOH GPs with a clinician practitioner, senior nurse lead and an administrative function while Hywel Dda uses GPs, pharmacists and senior nurses along with administrators and drivers trained as healthcare support workers alongside two advanced paramedic practitioners.
Nick Ramsay, chair of the public accounts committee, said: “People don't fall ill or hurt themselves between 9am and 5pm, so out-of-hours services are an essential part of the NHS in Wales.
“We are deeply concerned at the low morale among the staff delivering these services and sympathise hugely with staff who are often working alone and under pressure due to unfilled posts across the country.
“There are examples in Wales of health boards taking a different approach to out-of-hours, often with multi-disciplined teams to share the load and broaden the expertise on offer.
“We would like to see these examples of best practice shared across the country and urge the Welsh government to continue its efforts to provide a service which works for staff and patients.”
The committee made eight recommendations in its report, including that the Welsh government:
- share good practice in making OOH services more attractive places to work
- review the way it allocates funding to health boards for OOH services to ensure that allocations more accurately reflect the current service needs and provide greater transparency in terms of investment and actual spend
- actively develop policies to increase GP numbers.
British Medical Association (BMA) Cymru Wales welcomed the report but said the committee needed to set concrete dates for the various recommendations it had put forward.
Dr Charlotte Jones, member of the BMA's Welsh GP Committee said: “We would like to see it go further with a specific timeframe for implementation and measures for these improvements to be assessed against.
“We share the committee’s concerns over the decline in GP numbers across Wales. The Welsh government must actively develop policies to increase the number of GPs in Wales.
“BMA Cymru Wales has repeatedly warned of the growing gap between the demand placed upon general practice and its capacity. Years of underinvestment, along with rising workload has meant that GPs in Wales are increasingly being asked to do more with less, and out-of-hours care has suffered some of the worst effects.
“We are inundated with stories from our members citing issues with shift filling and trouble across a wide geographical area in out-of-hours coverage, with one member speaking of as little as one nurse practitioner left in charge across two hospitals covering around 280,000 patients. To help combat this we would urge Welsh government to support the further development of multidisciplinary teams, but not as a replacement for doctors.”
*Primary Care Out-of-hours Services, National Assembly of Wales Public Accounts Committee, July 2019.