Exhausted GPs shun out-of-hours work. The long term result of rationing medical school places, of declining skill standards, and governments showing they “couldn’t care less” for years.

The long term result of rationing medical school places, of declining skill standards, and governments showing they “couldn’t care less” for years is evident in this headline..

Chris Smyth reports in The Times 3rd Feb 2017: Exhausted GPs shun out-of-hours work

Image result for exhausted doctor cartoon


Millions of people have been left without access to a GP outside surgery hours because of staff shortages, a study has found.

Younger doctors are less willing to work nights and weekends and many are exhausted from their day job, leaving out-of-hours services struggling to attract qualified staff, GPs say.

Their leaders blamed the government for the “very concerning” findings, saying that the drive by ministers to offer routine weekend appointments had diverted doctors from out-of-hours services.

Last month Downing Street blamed an A&E crisis on a lack of convenient appointments and told surgeries to stay open longer.

Patients who need urgent care outside normal surgery hours are directed to out-of-hours services, but Freedom of Information responses from 104 such services by Pulse magazine found big gaps across the country.

In Tower Hamlets in east London a service for a quarter of a million patients had no GP available 12 times last year, while Wolverhampton’s service covering half a million people had vacant GP shifts on three occasions. In Peterborough there were nine occasions when a service covering 237,000 patients had no GP.

Overall, Pulse estimates that ten providers had periods with no GP, potentially affecting four million people.

Simon Abrams, chairman of Urgent Care UK, an out-of-hours business, said: “We are seeing a downgrading of services — shorter opening hours, longer distances to travel and fewer clinicians available. It is a worrying trend . . . erosion of these services not only raises clinical risk in the community but adds to pressure on A&E.”

Norman Lamb, the Liberal Democrat health spokesman, said: “Patient safety is being threatened by this government’s failure to recruit and properly fund our GPs. This is also putting more pressure on emergency departments that are already under impossible strain. Imagine what it must be like for a parent with a poorly child to be told there is no GP available and they will have to wait hours in A&E? Surely we can’t tolerate this in a 21st-century health service.”

Nine out of ten GP surgeries have opted out of providing out-of-hours care for their own patients under a deal in 2004, handing responsibility to a patchwork of companies and co-operatives. These deal with about six million urgent cases a year, about half of which are face to face. These services have reported increasing problems finding staff to cover shifts, with the rising cost of insurance meaning doctors who do such work only occasionally are finding it is no longer worthwhile. Other outside work is also available in private GP services, as A&E locums and doing weekend appointments for the “seven-day NHS”.

Chaand Nagpaul, chairman of the BMA’s GP committee, said: “There simply aren’t enough doctors to deal with the number of patients. Staff shortages have only been made worse by the government’s pledge to extend routine GP access over seven days, taking doctors away from urgent care into routine services and leaving out-of-hours rotas unfilled . . . It is completely unacceptable that funding is spent on extending routine access, increasing the shortage of GPs available to provide out-of-hours care.”

Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “Patients should always be able to access our care when they need it. That this report has found occasions where this isn’t happening is very concerning. It hammers home how important it is for the government to make good on its promise to deliver 5,000 extra GPs by 2020.”

• Hospitals will face a shortage of almost 450 trainee doctors in August when gaps in the rota will be seven times bigger than they were two years ago, according to predictions. Health Education England has 98 more applications than places available for the first year of medical training, but expects about 7 per cent to withdraw. It said that would leave 444 vacant posts, up from estimates of 307 last year and 64 the year before. It intends to run a second round of applications.

Dennis Cambell in The Guardian reports:  Doctor shortage left 4m patients without cover last year

Chronic shortfall of out-of-hours GPs meant some patients were sent to A&E or treated by non-qualified staff, figures show

Image result for exhausted doctor cartoon

From the correspondence:


Fact is this is the consequence of years where I should write decades of not funding attracting keeping enought doctors

We are now going through a work force nearing retirement age. Who has really lost the strength to carry on working late hours. When you are over 60, I am not about unsocial hours. Been there done that. I am simply unable to do it. By 10pm my eyelids close. And I have missed countless shows endings by 10:30. My body needs it’s beauty sleep. You could offer me a mountain of gold, I would not take it. All I want is my pillow.

This is the problem. An aging work force.

Doc Torrants

Whatever the ignorant and misinformed commenting below may believe about the cushy existence we have as doctors and GP’s in particular, the simple fact is that life has got much, much harder over the last 10 years as a GP.  The golden period, if there ever was one, was the late 90’s (just missed it…dammit!).  The workload has soared and funding has effectively been reduced.  A normal working day for a GP is 11-12 hours.  I still work out of hours shifts but am never far from quitting.  The shifts are pretty unrewarding and 50-75% of contacts are with the worried well, the ignorant or the self important and entitled.  Most of my colleagues don’t because they are exhausted and don’t need the extra hassle or wish to pay the extra extortionate medical defence organisation fees that they would have to in order to be covered for doing this.  You get what you pay for in life, and the government doesn’t spend enough on the NHS.  Simples.

This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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