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Out-of-hours services not sustainable, says top GP

By VICTORIA O'HARA

GP out-of-hours services across Northern Ireland are "unsustainable and potentially unsafe", a leading doctor has warned.

The comment was made by the chairman of the BMA(NI) GP Committee Dr Tom Black, who says family doctors now need to take control of services in a bid to transform them.

The BMA says there are fewer GPs working due to concerns over safety resulting in shifts not being covered.

This is combined with a demand for out-of-hours services growing by almost 20%.

In a bid to address the situation the Health and Social Care Board is injecting an additional £1m regionally for the service. This will boost staff by 20% over the Christmas, New Year and the March bank holiday.

But Dr Black said there was also a "clear need" for an education campaign to ensure out-of-hours services were used appropriately.

Addressing delegates at BMA(NI)'s annual conference for GPs held in Templepatrick, he warned the situation would become worse this winter.

Dr Black explained out-of-hours providers experienced difficulty filling shifts over the summer period and the BMA believes this will become worse in the next few months. "There is a tipping point where the level of GP staffing drops so low that doctors will regard the service as unsafe and will be obliged by the rules of good medical practice to stop working out-of-hours, something which the Northern Ireland GP Committee regards as impending", he said.

Funding levels for GP out-of-hours here are the lowest in the UK with average investment of £11 per patient per year, roughly 20 pence per patient per week to cover 126 hours of care.

Dr Black also said the current GP out-of-hours service has been cut to the point where it is much cheaper "but inevitably is costing more to the whole system of care".

"The only way forward as we see it is the adoption of a local, GP-led out-of-hours service which can significantly contribute to the priorities under Transforming Your Care," he said.

"We need a local, flexible, adaptable and responsive service for out-of-hours which will integrate with local emergency departments and ambulance services and better manage priority areas."

A spokesman for the Health and Social Care board said: "The Health and Social Care Board is firmly committed to commissioning high-quality GP out-of-hours services for the population of Northern Ireland."

Questions and answers

How does the out-of-hours service work?

It is there for people who need urgent medical treatment they would normally receive from their GP, but who cannot wait until the practice is open again. Services are provided in a number of centres. It operates from 6pm each weekday evening until the GP surgery opens the next morning, and 24 hours on Saturdays, Sundays and holidays.

Who are the current providers for out-of-hours care?

There are five GP out-of-hours providers. Each serves the population of the area of a health and social care trust.

So why are GPs concerned?

GPs who work out-of-hours services are paid extra but they say the issue is not with working extra hours or pay. Concerns were raised about recruitment problems during the summer, with out-of-hours sessions left unfilled leading to fears over safety. They believe more funding is needed for a new 'localised' system. In 2004 part of a new GP contract was that they had the option to opt out of out-of-hours care. New plans linked to Transforming Your Care are being discussed.

What would they want changed?

Reforms to the GP out-of-hours services favoured by General Practitioners Committee Northern Ireland would see them in control of both commissioning out-of-hours care through local commissioning groups and delivery through non-profit mutual providers.

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