The plans follow a report by Audit Scotland that found the number of GPs willing to work shifts during evenings and week-ends had fallen by 15 per cent in the 12 months to April 2007. It also found NHS boards were struggling to fill rotas (GP, 31 August).
The Scottish executive has confirmed that it is looking to nurses and other healthcare workers to fill the gap in out-of-hours care left after the new GMS contract allowed GPs to opt out of 24-hour responsibility. But GP leaders said nurses did not have the skills to cope with many life-threatening conditions and warned the plans were 'dangerous'.
GPC Scotland chairman Dr Dean Marshall told GP that there was no shortage of GPs wanting the work. Cost-cutting exercises were behind the amount of out-of-hours work being carried out by GPs, he said.
'Put simply, nurses cost less. Obviously money is an issue, but it is not the only issue. Clearly we have had a problem with getting GPs to do out-of-hours shifts. In my opinion the primary care organisations (PCOs) have done a lot to exacerbate the problem. In some cases they have given the shifts to nurses because they're cheaper,' he said.
In other cases, Dr Marshall said boards had closed local out-of-hours centres in favour of larger units: 'A lot of GPs liked working locally and seeing local patients and people from their community. So they are now less inclined to do it.'
'Nurses do a very important job but their training is different and patients may suffer,' he warned.
Ann Thompson, acting deputy director of the Royal College of Nursing, said to give nurses a greater role in out-of-hours work were welcome. 'There is no reason why patients will suffer if nurses are allowed to do the work that the PCOs are struggling to cope with,' she said.
'We are talking about highly-skilled nurses going out to carry out high-level triage in the same way that a GP would. Nurses are trained to diagnose the same problems and are capable of helping, just as a GP would do.'
- Ministers may employ nurses to fill shifts GPs no longer want.
- 15 per cent fewer GPs are interested in working out of hours than a year ago.
- GPC Scotland blames cost-cutting and closure of local 24-hour centres for decline in GP interest.