OUT-OF-HOURS GP services in Belfast were suspended for a second weekend running amid warnings the development has "huge implications" for all NHS services.
It has also emerged that higher pay rates for evening work at hospital 'urgent care centres' and Covid centres - at almost £90 per hour - have led some GPs to choose these as an alternative to 'Beldoc' shifts.
One leading medic said the pay difference was "definitely a factor" in reduced out-of-hours GP cover, adding it was "human nature" to be attracted to where the best rates are offered.
The Irish News last week reported the Beldoc GP weekend service was stood down for the first time due to chronic staffing shortages.
Patients were directed to the urgent care centre at the Royal Victoria Hospital, which was set up six months ago to reduce A&E pressures.
Belfast trust last night confirmed there was no GP out-of-hours cover for periods between last Friday night and Sunday - a move which led to a contingency plan for terminally ill patients and those experiencing serious mental health problems.
"Despite efforts to maximise rota coverage, our Beldoc base had to close at various times over the weekend," a trust spokesman said.
"Following on from last weekend's closures we have amended our contingency plan to ensure that even when any base is closed, a GP will be available at all times.
"This will be to support the closed base in dealing with vulnerable patients such as palliative care and those experiencing an acute mental health crisis. In addition, they will be available to provide support and prescriptions for our community nursing colleagues and other health professionals."
Despite the massive drop in coronavirus infections, the trust confirmed its GP-led Covid Centre at Beech Hall - where patients with suspected symptoms are assessed but not tested - was staffed by two GPs and 'one standby' over the weekend.
Dr Alan Stout, chair of the British Medical Association (BMA) NI GP committee, said the closure of the out-of-hours services will have a major 'knock-on' impact, particularly on hospital A&E departments.
"We’re massively concerned, it has huge implications for the whole service because patients need to contact a doctor and go somewhere," he said.
"So it’s absolutely critical we provide a primary care response. Its suspension will have an inevitable knock-on effect on Emergency Departments (EDs). We know that EDs are already under pressure.
"This is a problem that has been building for quite some time in the Western and Southern areas. It's now hit Belfast for the first time and it’s become an even bigger story."
Dr Stout said he was aware urgent care centres offered higher pay rates to GPs at weekends compared with £60 per hour for Beldoc shifts.
"The differential in pay rates is definitely a factor. We've got a constrained workforce, we don’t have enough GPs but we do still have some who will work in the out-of-hours environment and actually predominantly work in this environment," he added.
"There are some who will definitely be attracted to places that have the higher rates and that’s just human nature.
"But for some who don’t work regular out-of-hours, and who are based mainly in-hours, the actual pension regulations are having a big impact.
"So people might be prepared to work one or two sessions but are going to get taxed heavily on it because they’ll exceed their pension thresholds. They’ll get taxed more than they’re actually earning - so there are very clear reasons why people won’t do it."
The BMA representative said the fallout from the pandemic was being felt across the profession.
"What we’re seeing in practice at the moment, the pressures, the demands and all these delayed diagnoses - you cannot underestimate the impact that’s having on our workforce. We’ve got an exhausted workforce, people are struggling.
"It’s important to emphasise that patients are still being seen. There are over 200,000 contacts to general practice a week - a third of those are being converted to face to face.
"But we need more GPs, bigger teams, more receptionists and more phone lines...with the demand at the moment, the existing service cannot cope."
