English county where ONE GP covers home visits for 500,000 patients: Shock figure reveals crisis in out-of-hours NHS care that has ‘left dying cancer patients in agony with no one to administer morphine’
- One doctor in Shropshire is responsible for an area of 1,346 square miles.
- A clinic in Kent had only two doctors to look after 1.4million patients overnight
- Family doctors can opt out of working unsociable hours, weekends and evenings
- The state of out-of-hours care in Shropshire has led to patients dialing 999
A single GP is having to cover night-time home visits for a population of half a million.
In a stark illustration of the crisis in out-of-hours care, the doctor is solely responsible for an area of 1,346 square miles.
Ten years ago, eight GPs shared the workload in Shropshire. The situation is blamed on lack of cash and a shortage of GPs prepared to carry out unsocial hours.
Cover is so poor that patients trying to see a doctor at evenings or weekends have been told to drive an hour over the border to get help in Wales. A mother of a sick child was offered consultations an 80-mile round trip from her Ludlow home.
Dying cancer patients have been left in agony because there was no GP available to administer morphine.
And sources say on some nights there is no GP cover at all – a claim vehemently disputed by Shropdoc, the firm charged with providing the service.
In November, an out-of-hours provider in Kent admitted that on one night it had only two doctors to look after 1.4million patients.
The problems stem from a contract negotiated under Labour in 2004 that allowed family doctors to opt out of responsibility for patients at evenings and weekends (stock image)
Dr Richard Vautrey of the British Medical Association said too many providers were struggling to meet demand. ‘Their budgets have flat-lined in the past decade and the number of cases requiring help is increasing,’ he added.
‘Many areas, particularly rural locations, are struggling to recruit GPs. If you are working longer hours during the day you may be less willing to do another four or six hours overnight.’
Professor Helen Stokes-Lampard of the Royal College of GPs said: ‘It is essential that any out-of-hours care services are staffed appropriately to meet demand, and by sufficient numbers of appropriately-trained healthcare professionals.
‘This is not the first time we have heard of situations where this may not be the case, and this must be addressed.’
The problems stem from a contract negotiated under Labour in 2004 that allowed family doctors to opt out of responsibility for patients at evenings and weekends.
Care was placed in the hands of commissioning units which subcontracted it to private firms and co-operatives – groups of doctors.
But in recent years GPs have become increasingly unwilling to do shifts. The fragmented state of out-of-hours care every night in Shropshire has led to a huge increase in patients going to A&E and dialling 999.
Professor Helen Stokes-Lampard, of the Royal College of GPs, said it is essential out-of-hours services are appropriately staffed
A board meeting of the Shrewsbury and Telford Hospitals trust two weeks ago was told casualty admissions were 13 per cent up on last winter and ambulances arrivals had increased by 17 per cent.
Although there is a second GP working at night carrying out ‘triage’ assessments on the phone they are not available to do consultations or home visits. And this doctor is also responsible for triaging incoming NHS 111 calls from Wales.
Shropdoc insists that patients can also be seen by one of two ‘urgent care practitioners’ – who are either nurses or paramedics.
Freedom of information requests by the Mail show that out-of-hours provision is hugely patchy. In Milton Keynes, Bucks, there is one GP overnight for 290,000 patients, Cornwall has three GPs for 575,000 and Oldham has one for 230,000.
Dr Simon Chapple, medical director for Shropdoc, said that claims there was no doctor cover on some nights was ‘absolute rubbish’.
He said the service had been struggling to fill shifts due to an NHS scheme that sees surgeries offer appointments in the early evening and at weekends, taking GPs away from out-of-hours work.
An NHS England spokesperson said: ‘Evening and weekend GP appointments are now available to people in every part of the country, delivered by the extra 5,000 professionals now working in primary care compared to just a few years ago, and our NHS Long Term Plan will mean that this vital progress is maintained, with online consultations for everyone who wants one and physios and therapists based in GP surgeries, all supported by record-high funding.’