GP out of hours services struggling to fill shifts

Shortages have been partly blamed on senior medics’ reluctance to sign up to extra work which could see them hit with hefty pension tax bills.

OOH clinics - usually based on hospital campuses - are designed to provide access to GPs during evenings, weekends, and public holidays when practices are closed.

Every health board - except Tayside - reported a reduction in the number of GPs working in its out-of-hours service compared to 2019 (*figures unavailable for Highland, Borders and Orkney) (Image: PHS)

However, there are fears that the situation is putting patient care in jeopardy with the Royal College of GPs Scotland (RCGPS) warning that there are “no contingencies should out-of-hours services collapse”.

Excluding Highland, Borders and Orkney, where data was missing or unreliable, the PHS report found that the headcount for GPs working in OOH had fallen by 23 per cent from 1,568 in 2019 to 1,205 in the year to March 2022.

This contrasts to previous surveys from 2015 onwards where GP staffing levels in OOH had appeared stable.

READ MORE: Exodus of nurses leaving profession rising faster in Scotland than rest of UK

In the year to March 2022, just 9% of the GPs working in the service accounted for nearly half (44%) of all the hours of cover provided.

In NHS Fife and Forth Valley, the OOH GP headcount has more than halved since 2019, while in Greater Glasgow and Clyde numbers are down by 27%.

In its report, PHS said eight of the health boards surveyed were taking action “at least weekly” - including two on a daily basis - to ensure OOH shifts were filled.

This included staff working longer hours or using nurses to cover GP shifts. One board said it was using paramedics on a weekly basis to cover a GP shortfall in OOH.

Finding cover was a “particular difficulty” during summer holidays and the festive period, said PHS.

The out of hours GP workforce has declined by headcount and whole-time equivalent (where GP numbers are counted per 40 hours/week worked) (Image: PHS)

Forth Valley reported that 50% of its OOH shifts were unfilled at least 48 hours prior to public holidays and weekends, while Borders said it has sometimes been forced to divert patients to A&E instead due to a lack of OOH capacity.

PHS said several boards had referenced “the impact of early retirements and pension taxation” for their difficulties in recruiting GPs to the OOH service.

Its report added: “Boards reported implementing steps such as closing a site or working with a skeleton staff.

"[Advanced Nurse Practitioners] were also used to strengthen workforce where GP gaps were identified...Another contributory factor suggested for the decrease in GPs working in OOH was the continued demand for GPs in the in-hours workforce could mean that some GPs may be taking more desirable daytime shifts which are available, rather than OoH, especially where there is little difference in payments.”

READ MORE: Number of GP surgeries closed to new patients 'at record level - and rising'

Dr Andrew Buist, chair of the BMA’s Scottish GP Committee, warned that the situation is "unsustainable and puts those still working in the service at risk of exhaustion and burnout".

He added: “Patient demand is outstripping GP capacity across the whole service, including out of hours – we simply do not have enough GPs in Scotland."

By headcount, the total GP workforce in Scotland has grown by just 2.2% since 2012 at the same time as the number of registered patients has increased by 6% - including a 20% spike in the number of patients over 65, who require the most care.

Male GPs aged 60-plus worked the most hours a week on average in out-of-hours services (Image: PHS)

Dr Catriona Morton, deputy chair of RCGP Scotland, said the figures on OOH GP numbers were "very disappointing" but came amid "very high levels of demand" on day-to-day general practice.

She said: "GPs are not contractually obliged to work in the OOH service, and after facing these immense pressures during in-hours general practice, many report not feeling able to work in OOH too.

"It is crucial that OOH general practice be a place where GPs and other doctors feel supported, not overwhelmed, and can work safely."

READ MORE: 'Shock and outrage' as Cancer Research UK axes funding for its only Scottish clinical trials unit

Jackie Baillie, Scottish Labour's health spokeswoman, said patients were "paying the price for the SNP’s disastrous workforce failures", while the Scottish Conservatives' Sandesh Gulhane - a GP in Glasgow - said doctors were "exhausted" and would be "potentially be putting ourselves and [patients] at risk by carrying out additional shifts".

The Scottish Government said the Health Secretary had repeatedly written to the UK Chancellor urging him to resolve the pension tax issues which disincentivise medics from working extra hours in the NHS.

A spokeswoman said: “There are now a record number of GPs working in Scotland, with more per head than in the rest of UK, and we are on track to deliver on our commitment of 800 additional GPs.

"Trainee recruitment in 2021/22 has been the most of any of the last five years, with 98% of GP training posts now filled."