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Out-of-hours GP pressures soar as patient claims rise

GP out-of-hours doctors are struggling to cope with demand in Northern Ireland
Seanín Graham

HIGH-RISK out-of-hours work by GPs and soaring number of claims have led to their insurance premiums doubling in five years.

One leading Northern Ireland medic has warned the hike in 'indemnity' protection – a GP must insure themselves while a hospital doctor is insured by the NHS – is acting as a "real disincentive" for those who receive emergency calls to attend patients at night.

Reduced access to medical records, sicker patients and massive workloads with fewer doctors are among the key risks faced by GPs working after 6pm - and in particular those on the 'red-eye' midnight to 8am shifts.

Meanwhile, advertising by medical negligence solicitors and "higher patient expectations" of GPs has led to the explosion in patient payouts, according to one indemnity expert.

The development comes as the out-of-hours service across the north struggles to cope with demand.

The Irish News has learned that the Southern area - which covers an area stretching from Kilkeel to Dungannon - dealt with 2,000 calls to its out-of-hours service last weekend alone resulting in delays of up to nine hours for GP call-backs.

The Western and Northern trusts had a spike in referrals on December 28, when they tackled 2,518 calls between them.

A knock-on effect has been felt on hospital A&E departments, with officials pleading that only the most urgent cases attend.

Dr Frances O’Hagan, an Armagh based-GP and experienced out-of-hours doctor, described last Sunday's caseload in the Southern area as "horrendous".

"I do the red-eye shifts and it is a huge geographical area to cover - I could be in Pomeroy and get a call to do a house visit on the far side of Lurgan - the travel could take hours. Between midnight and 8am there are just two doctors but between 6pm and 12am there's at least six. Last Sunday was so bad that extra GPs came in who weren’t rostered to work," she said.

"You need to have really experienced doctors with a good head on their shoulders to do this work due to the huge amount of stress, pressure and the sheer volume of calls.

"Indemnity has become a really big issue. You pay at the beginning of the year to insure yourself for out-of-hours work and I am rostered for two a month. The problem is once you go over your allocated amount you could pay thousands of pounds extra - so if you’re called to deal with an emergency like last weekend and you’re not insured you can’t go out. It’s a catch 22 and a real disincentive to do emergency sessions. The knock-on effect is on A&E."

Dr Mike Devlin, head of professional standards at the Medical Defence Union in London, an organisation which provides indemnity cover to many Northern Ireland GPs, said there had been a year-on-year rise in patient claims.

"Northern Ireland is following the same sort of trajectory as England and Wales in terms of GP claims and especially out-of-hours due to the higher risks involved. The cost of the claims are much higher also, with the majority relating to missed or late diagnoses," he said.

Dr Devlin revealed that between 2008 and 2012, £28 million was paid out in claims across the entire NHS in relation to just 17 cases involving meningitis patients. Of this, five related to GP out-of-hours care. It is not known if any of these cases related to the north.

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