Doctors: we need help to meet out-of-hours demand

Leaders of a group which brings together services that take over when GP practices lock-up, such as NHS 24 and out of hours medical hubs, took the unusual step of speaking out as the figures were released.

They say the number of patients who need to see a GP out of hours has risen, their problems are more complex and there are fewer doctors willing and available to provide the care.

Dr Norrie Gaw, co-chair of the National Operations Group for out of hours services, said GPs in Glasgow were now seeing up to 30 patients each between 6pm and midnight. In the past, he said, 18 consultations represented a busy shift.

He also said doctors based in cars carrying out home visits could once be called on to help out at the centres, but now they too had so many patients to see they were rarely free. He said: "The resilience in the service is no longer there because everyone who is working is really pretty fully occupied."

This more intensive workload is thought to be among a number of factors putting off doctors from working the late shifts.

Dr Sian Tucker, who also chairs the National Operations Group, said : "Like the whole of primary care, the out of hours is finding it challenging to recruit to cover its rotas."

Health boards such as NHS Lanarkshire and Tayside had to centralise evening GP services this summer because of shortages of doctors. Dr Tucker said even in her city it had become more difficult to cover shifts, particularly at weekends. A few years ago, she said, the rota was filled well ahead at time, with only sickness absence cover to find at short notice. Now, she said, staff had to work every day to find enough GPs to man the service.

She said: "I think it is best and safest and what patients want, to be looked after in the community. To enable that to happen we do need increased resources within both health and social care to ensure that we can provide all the patients need."

The Scottish Government has already commissioned a review of GP out of hours services and Professor Sir Lewis Ritchie, who is leading the project, has travelled across the country discussing the issues with staff and looking at potential solutions.

Health Secretary Shona Robison welcomed the new data, which showed on average 75,000 patients were seen by GP out of hours centres between April 2014 and the end of March 2015. She said: “The information will also help support the National Review of GP Out-of-Hours Services, announced earlier this year, which is considering how best to deliver these services in light of the challenges of Scotland’s ageing population, and the new ways of working that health and social care integration will bring.”

Both the National Operations Group and the Royal College of Nursing Scotland emphasised nurses as well as other health professionals could play a key role in seeing patients during evenings and weekends.

Norman Provan, associate director of RCN Scotland, said: "Senior nurses working at an advanced level of nursing practice are already making a significant contribution in some parts of the country to effective out of hours care. Investment is needed now to make sure their potential, as part of a multidisciplinary team, is realised and that their expertise is shared right across the country."

Dr Tucker said she was very proud of the out of hours service and delighted it was being recognised by the new figures and the Scottish Government's review.

She stressed working in the out of hours service was a good job for GPs, offering flexible hours. Dr Gaw said: "We have to make the work more attractive and that means less busy....It is not about pay, it is about working conditions and we have got to realise that the service has got busier."