In the latest sign of the winter crisis engulfing parts of the NHS, Urgent Health UK (UHUK), which represents social enterprise providers, said its members had seen a significant increase in demand compared with last year.
The reports come as health secretary Jeremy Hunt suggested GPs could be asked to help support urgent care work as hospitals and ambulance services in parts of England struggle to cope with unprecedented demand.
The Red Cross last week declared a ‘humanitarian crisis’ in parts of the NHS as it was asked by some trusts to help provide support for patients as hospitals across the country declared alerts. The Royal College of Emergency Medicine has said A&E’s were facing unprecedented demand and performance was the worst in a decade.
Primary care demand
Twelve GP out-of-hours providers reported year-on-year demand increases over the holiday period of up to 15%, the UHUK poll found.
Providers also reported continuing staffing problems, an issue raised in a National Audit Office report published on Wednesday that found that extended hours schemes rolled out by the government were competing for the same staff that out-of-hours organisations rely on, and overlapping with the service they provide.
Most organisations surveyed, however, said NHS England’s £30m winter indemnity programme to cover out-of-hours insurance costs had helped recruitment. They also reported increases in 111 calls as well as busier secondary care.
UHUK chair Dr Simon Abrams said that despite out-of-hours providers seeing higher demand than in recent years, local systems and provider organisations had been better prepared with special arrangements in place ahead of the Christmas period. But there were continuing problems filling out-of-hours sessions.
Dr Abrams called for the GP out-of-hours sector to be given proper recognition for the role it plays. ‘I firmly believe we are not given the credit for how much work we actually keep out of A&Es,' he said. ‘And good out-of-hours services that work effectively throughout the winter and the rest of the year will absorb a lot of work that might otherwise turn up at A&E. We see a huge number of patients.’
Commissioners in some areas had given providers additional funding in the run up to Christmas, Dr Abrams said.
While providers recognise funding is a difficult issue, said Dr Abrams, there is a problem with pay in the out-of-hours service where GPs can be paid up to £30 an hour less than the daytime locum rate. ‘I don't think that is equitable,' said Dr Abrams. ‘I think the market forces are harder at work in daytime locums and that is pushing prices up. Whereas the out-of-hours services on block contracts it has stayed down, but it makes life very difficult for out-of-hours services and unfortunately that is probably probably part of the A&E effect ... we can't recruit adequate numbers of GPs.’
Dr Abrams appealed to Jeremy Hunt, who this week said that seven-day GP services could help solve the A&E crisis, to focus on strengthening existing out-of-hours services rather than setting up alternative systems. ‘We know those sorts of initiatives put in place at short notice destablise the workforce’, he said. ‘GPs get offered more money to go and work with them. They'll see fewer patients, and yet the out of hours service with more resources would be able to do better than setting up a new initiative which destablised the workforce.
‘I would say to him that your principle is right but your practice is not going the right way. You need to look at the out-of-hours service which is already set up to take the calls direct the patients and appoint the extra GPs. But they would need extra resource to do that.’