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Declining number of GPs working in out of hours in Scotland

by Beth Gault
22 February 2023

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The number of GPs working in out of hours services across Scotland is declining, according to a new report, which the RCGP has suggested is due to the pressures of in-hours general practice.

There were 1,568 GPs working in primary care out of hours services in Scotland in 2019, equating to a whole time equivalent (WTE) of 226. But in 2022, headcount dropped to 1,205 and WTE to 184.

The report into the primary care out of hours workforce, published by Public Health Scotland, found that eight out of the 14 Health Boards in the country have had to take ‘additional action’ at least weekly to ensure shifts are filled. This includes extending shifts, having nurses cover GP shifts, reducing triage cover or using on-call/stand-by/backup shifts. One board, NHS Borders, reported having to divert patients to A&E when shifts could not be filled as planned.

It also found that 9% of GPs worked 1,000 hours or more over the year in out of hours services, accounting for almost half (44%) of the total GP hours worked – meaning provision is reliant on a ‘relatively small’ number of GPs. Those over 45 years old worked a higher average number of hours per week than their younger counterparts, with the highest hours worked by GPs aged 60-64 years old.

Health Boards said in the survey report there were issues with recruiting GPs but that early retirements were also having an impact. The current tax and pension system were also noted by some boards as being ‘a deterrent to GPs working out of hours shifts’.

RCGP Scotland said the results were ‘highly disappointing’ and given the demand on in-hours general practice overall, many GPs have reported not feeling able to work in out of hours services too.

Joint chair at RCGP Scotland, Dr David Shackles said: ‘General practice has been facing very high levels of demand, sustained over long periods.

‘It is crucial that out of hours general practice be a place where GPs and other doctors feel supported, not overwhelmed, and can work safely.’

Dr Shackles warned that ‘there are no contingencies should out of hours services collapse’, and called on the Scottish Government to take action to ensure it could continue to operate.

This should include retaining and recruiting a sufficient number of GPs, making improvements to daytime working and addressing pensions issues, he said.

Dr Shackles added that it ‘is imperative that every out of hours service has defined and sufficient senior GP leadership posts’ and that there be options for salaried doctors to work in the service too.