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Need to raise morale and standards in GP out-of-hours services


Taking a multi-disciplinary approach to Primary Care out-of-hours service could boost staff morale and raise standards according to the National Assembly's Public Accounts Committee.

The Committee is extremely concerned at how unattractive out-of-hours services are to medics who cite lone working, working under pressure due to unfilled shifts and not feeling part of a valued team as reasons for low morale.

In rural areas the issues are magnified with GPs covering vast geographical areas and faced with difficult logistical decisions in terms prioritising patients, often alone.

The Committee learned about innovative schemes operated by Cardiff and Vale University Health Board and Hywel Dda University Health Board.

Cardiff and Vale supports out-of-hours GPs with a clinician practitioner, senior nurse lead and an administrative function.

Hywel Dda uses GPs, pharmacists and senior nurses along with administrators and drivers being trained as healthcare support workers. There are also two advanced paramedic practitioners (APPs) undertaking home visits and contributing within treatment centres.

"People don't fall ill or hurt themselves between 9am and 5pm, so out-of-hours services are an essential part of the NHS in Wales " said Nick Ramsay AM, Chair of the Public Accounts Committee.

"We are deeply concerned at the low morale among the staff delivering these services and sympathise hugely with staff who are often working alone and under pressure due to unfilled posts across the country.

"There are examples in Wales of health boards taking a different approach to out-of-hours, often with multi-disciplined teams to share the load and broaden the expertise on offer.

"We would like to see these examples of best practice shared across the country and urge the Welsh Government to continue its efforts to provide a service which works for staff and patients."

The Committee makes eight recommendations in its report, including:

  • The Welsh Government share good practice in making out-of-hours services more attractive places to work;
  • The Welsh Government reviews the way it allocates funding to health boards for out-of-hours services to ensure that allocations more accurately reflect the current service needs and provide greater transparency in terms of investment and actual spend; and,
  • The Welsh Government actively develop policies to increase GP numbers

The report will now be considered by the Welsh Government. 


Read the full report:

Public Accounts Committee Report - Primary care out-of-hours service (PDF, 599 KB)


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