Doctors make shock claims about out-of-hours GP service covering West Norfolk

Dozens of doctors have warned of risks to patient safety and say they are being used as “cannon fodder” for coronavirus, as shock claims about the “denigration” of out-of-hours GP service across Norfolk emerge.

A total of 48 Norfolk GPs have written to the firm behind the county’s urgent care service, including clinics in Lynn and Fakenham, warning of a “danger to patient safety” and a “public health issue” in the way the system is run.

Doctors claim Integrated Care 24 (IC24) intends to replace “the safe, high-quality GP-led service with a cheaper nurse-led out-of-hours service”, which they say will “inevitably lead to an increase in medical mishaps, including preventable deaths”, with the public in the dark about “these impending changes”.

But IC24, which runs out-of-hours clinics across Norfolk and Waveney, deny the claims.

Chief executive Dr Andrew Catto said: “It is patently untrue to state that doctors and GPs are being rapidly reduced. I am personally committed to ensuring a safe and effective service.”

And a spokesman for the firm said they were “sorry” letters about new clinical assessment tools sent to staff in Norfolk “did not reflect our corporate position”.

The company, which says it is run as a social enterprise (not-for-profit), operates clinics in Beccles, Dereham, Fakenham, Yarmouth, Lynn, North Walsham, Norwich and Thetford.

The letter, signed by 48 GPs who work shifts for IC24 in Norfolk, outlines a number of concerns, including:

• One doctor having been the sole GP covering the whole of Norfolk on an overnight shift

• Patients – including those on end-of-life care – waiting hours “due to the dearth of GPs”

• Nurses and paramedics on shifts being unable to treat babies, pregnant women, mental health patients and palliative patients

• “Terrible, unsafe and dishonest” phone triage system

• Patients denied appointments without speaking to a clinician

• Management focus on data and “forgetting we are dealing with precious human lives”

• “Inferior IT infrastructure” and “relentless pressure to see more patients more quickly”

• GPs having to see Covid-19 patients at clinics without full PPE and access to showers, being “treated as cannon fodder with no concern for health and safety”

• Black, Asian and minority ethnic (BAME) doctors not having coronavirus risk assessments

• “No consideration of anxiety and stress” GPs experienced during the Covid-19 pandemic

• A productivity management system designed to have GPs “compete with colleagues for a dwindling number of shifts”

• And being treated in a “highly unprofessional manner” and the creation of a “toxic workplace”

The letter said: “This is a very unsafe service with the doctor patient ratio extremely high.”

And the doctors have made a series of demands, including an end to productivity management, IT issues being resolved, a pay increase in line with risk, and new, clear protocols for treating Covid-19 patients – and given IC24 until Tuesday, September 15, to agree to “reasonable requests”.

One doctor, who wished to remain anonymous, said: “There is only one GP sometimes at night for the whole of Norfolk. This is an out-of-hours GP service.”

And the GP said if IC24 did not agree to their demands, the doctors were prepared to “escalate matters” to the Care Quality Commission (CQC), the Department for Health and Social Care (DHSC), and the health secretary Matt Hancock.

Dr Andrew Catto, chief executive of IC24, said: “I was personally disappointed to receive a letter of concern from a number of GPs. As chief executive and a former hospital consultant physician, I am personally committed to ensuring patients in Norfolk and Waveney receive a safe and effective service.

“All colleague concerns are taken seriously. I have directed our chief medical officer and chief operating officer to urgently investigate the matters raised.”

He added: “Integrated urgent care is a multi-professional speciality. The service is delivered by a team of health professionals including doctors, nurse practitioners and urgent care practitioners, such as paramedics.

“This is exactly the same as a typical GP surgery. It is patently untrue to state that doctors and GPs are being rapidly reduced.

“We do not have ‘target based’ shifts, however I am determined to ensure that all patients get the care they need and deserve in a timely manner.

“However, we recognise that GP colleagues may need additional help and support to ensure they can fully meet the needs of our patients. We have a system that allows colleagues to understand how they are performing.

“I deeply regret if colleagues consider this support is as ‘bullying’. It is not.

“It is intended to improve our systems for patient benefit. In common with all NHS services, we occasionally experience peaks in demand and regrettably this can result in delays. I am committed to ensuring that this is kept to an absolute minimum.

“We are satisfied that our urgent care services are Covid secure. We constantly keep this under review and I welcome any feedback that GPs wish to share.”

An IC24 spokesman said staffing was “categorically not a deliberate IC24 policy to replace GPs” and models were “regularly audited and scrutinised”.

He added: “We can confirm that no significant incidents have been raised by GPs over the past 12 months regarding service delivery or patient safety.

“We strongly refute the suggestion that IC24 intends to pressurise BAME clinicians into accepting shifts without appropriate risk assessments.

“IC24 has sourced PPE in excess of Public Health England requirements and are currently in the process of confirming supplies should there be a further surge.”