Leaked documents reveal only one GP covered more than 900,000 people in Norfolk and Wisbech

07:00 16 February 2016

A GP checks a patient's blood pressure.  Photo credit: Anthony Devlin/PA Wire

A GP checks a patient's blood pressure. Photo credit: Anthony Devlin/PA Wire

The region’s out-of-hours GP service had only one doctor covering a population of more than 900,000 on certain nights, internal documents leaked to the this newspaper have revealed.

Staff rotas for service providers Integrated Care 24 (IC24), provided to us by an NHS whistleblower, reveal:

- There was just one GP covering Norfolk and Wisbech overnight on at least three weekend days throughout January.

- A snapshot picture of an out-of-hours home-visit list one day showed the service had breached maximum waiting times for 11 of 25 patients.

- On one Saturday a GP worked a 15-hour shift in Thetford.

Health watchdog aware of concerns

Health watchdog the Care Quality Commission (CQC) told this newspaper it was aware of the concerns over the service provided by IC24 and confirmed it would carry out an inspection “in due course”. It comes after Liberal Democrat MP for North Norfolk Norman Lamb wrote to the CQC requesting an urgent and unannounced inspection after he was contacted by a whistleblower within IC24.

Mr Lamb, who was not aware his letter to the CQC had been passed to this paper when we rang him, said: “I felt the issues raised were serious enough to justify an urgent CQC investigation.”

A spokesman for the CQC said: “We are aware of concerns at IC24 and our inspection team have met with the provider to discuss this. We are closely monitoring their action plan and information received.”

The spokesman did not want to comment on when the CQC’s inspection would be carried out.

Clive Lewis, Labour MP for Norwich South, said the news was “more meat on the bones” of the problems with local out-of-hours care.

“I’ve spoken with both Norwich CCG and IC24 since then and have had reassurances that progress is being made on the problems. “However I can’t just take those reassurances at face value, which is why I’ll be meeting confidentially with staff.”

- There are also several unfilled GP shifts during the day on Saturdays and Sundays.

Former health minister Norman Lamb has called for an urgent and unannounced inspection of the service after he was contacted by a separate whistleblower.

He said: “If these issues are true then that’s not acceptable and they have to be resolved straight away.

“This is potentially about life and death.”

Mr Lamb has written to health watchdog the Care Quality Commission (CQC) urging them to carry out an unannounced inspection.

The whistleblower who contacted this newspaper, and whose identity we are not revealing, claims “patient safety is not a priority” and that a severe shortage of GPs working in the service in causing excessive hours of waiting for patients.

We put the figures provided by our source to officials at IC24, but they did not respond directly to these.

Instead, we were provided with a copy of a letter sent to IC24 staff by chief executive Yvonne Taylor.

She said it was committed to delivering an integrated urgent care service which is GP-led and in line with NHS England’s vision.

The controversy comes just five months after IC24 began providing the NHS 111 and out-of-hours GP services following a handover by East of England Ambulance Service Trust.

Last month a report by Norwich Clinical Commissioning Group, which awarded the contract to IC24, concluded the CCG was not clinically assured of the safety of the services.

In its report, the CCG said it had been made aware of occasions when “only one or two GPs were available for Norfolk and Wisbech”.

In addition, new official figures show an increase in the number of 111 calls that resulted in an ambulance response since IC24 took over the contract.

This has fuelled fears that patients left waiting by the 111 and out-of-hours GP services are dialling in 999 in desperation for help.

Our source, a medical worker who also worked for out-of-hours GP service when it was provided by the ambulance trust, warned “patient safety is not a priority at IC24”.

The source said: “Patient waiting times being breached is a common occurrence.”

According to the source, there used to be up to four out-of-hours GPs working overnight based in Norwich, Thetford, North Walsham, and King’s Lynn, when the service was provided by the ambulance trust.

But the rotas suggest IC24 is struggling to fill overnight GP shifts at Norwich and Thetford, while shifts at King’s Lynn are covered by advanced nurse practitioners or emergency care practitioners (ECP).

These medical staff do not have the same levels of training, expertise, and ability to dispense drugs as GPs.

The source alleged IC24 is hiring paramedics, some of whom have limited training and experience in primary care.

The source said: “For example ECPs hold recognised primary care qualifications and were trained in GP surgeries, whereas paramedics’ experience is mainly in emergency care.”

In response IC24 said in its letter it was changing the staff’s skill mix from a GP workforce to a “broader skill mix best able to meet the needs of the patients”.

Meanwhile the source warned excessive waiting times were forcing patients to seek help by calling 999 instead.

And figures revealed the monthly average ambulance emergency responses seen in Norfolk when the ambulance trust operated the service was 852 per month, only for this to rise to 1,015 since IC24 took over.

Mr Lamb added: “Anthony Marsh (former chief executive of the ambulance trust) raised concerns with me about this when he was chief executive and we have to take note of these concerns.”

In her internal letter to staff, used by IC24 to respond to this newspaper’s questions, Yvonne Taylor said: “The new service is not the same as that previously delivered with a different model and geography.

“We are tasked with delivering an intergrated urgent care service which is GP-led.

“The service model that CCGs have commissioned is completely in line with NHS England’s Vision for Transforming Urgent and Emergency Care services in England.

“We have developed a new GP oversight role to work clinically across 111 and out-of-hours to support clinical decision-making and reduce access times for patients who need to be seen face-to-face.

“We have been and continue to recruit paramedic practitioners who function within our organisation. These staff have additional training in clinical assessment, minor illness, and the competencies necessary for the roles they are fulfilling.

“We have put a number of things in place to support all staff – staff meetings, senior management visibility, chief executive officer open-door session (by phone or in person).

“We are also absolutely committed to being open and transparent about the challenges we face with CCG colleagues, MPs, as well as the press.”

She said she and IC24’s chairman Judy Oliver will visit bases in Norfolk this week.

Alex Stewart, of Healthwatch Norfolk, said some GPs who worked for the ambulance trust did not want to switch to IC24 because it would increase their indemnity insurance.

This is an obligatory insurance paid by medical staff to cover costs of negligence or malpractice.

Mr Stewart said this issue is being addressed nationally and added he was assured weekly meetings between the CCG and IC24 means progress is being made.

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  • Congratulations are in order to the brave whistleblowers in the NHS and other in other public services,such as the one to reveal the truth here.They act in the full knowledge that their employer can make their lives hell and can destroy their future careers-unless they sign gagging clauses.They deserve the full support of the public,their trade unions and their legal representatives.It is high time the secret NHS blacklists of such heroes,and the private vested interests of their persecutors, were made public.Thankfully,not everyone is motivated by greed and private profit.

    Report this comment

    Peter Watson

    Tuesday, February 16, 2016

  • This what the Tories wanted less home grown doctors who are not prepared to be pushed around.In ten years time visiting a GP will be like phoning a BT call centre and we all know what that entails.

    Report this comment


    Tuesday, February 16, 2016

  • Big thankyou must go out to Jeremy Hunt and his little Tory friends (& voters). Sounds like you're getting what you wanted.. the decline and dismantling of the NHS. Aneurin Bevan will be rolling in his grave.

    Report this comment


    Tuesday, February 16, 2016

  • Bad form suggests that 12 years ago tony Blair started the rot. Who cares? It's what is happening now, and during the care of this government, that the situation is deteriorating so rapidly. Not enough doctors being trained or recruited, doctors leaving the profession due to dear Jeremy, and an ageing population. Great. Trust the Tories to sort it out? Another pink pig has just gone flying past my window!

    Report this comment


    Tuesday, February 16, 2016

  • @Catseye. Sadly, you are right. To all those who voted Tory- thanks - we are now on the road to losing the NHS. Break it down, convince people it's not working then sell it off to the corporations. Why can't people see what is happening? The NHS is, in my opinion, the MOST important institution in the UK and to lose it would be a disaster. For all those wanting taxes to come down so they have a few quid extra in their pocket- think about how much more health insurance or private care actually cost you overall. Sad times.

    Report this comment

    Fluffy Cat

    Tuesday, February 16, 2016

  • Unfortunately neither the private sector nor NHS is able to provide enough Doctors to staff the out of hour’s service effectively in England. Whilst Labour have tried to distance themselves from this mess it was Tony Blair’s government who in 2004 changed GP contracts and caused the problems being experienced in both A&E and the out of hours service. Unfortunately, the rot has set in and neither Labour nor the Conservative Party has any ideas how to stop it. With the Conservatives hell bent on making it harder to recruit nurses and other allied health care professionals and Jeremy Hunt doing his damnedest to alienate Junior Doctors the NHS’s future is looking decidedly bleaker no matter who is running the government!

    Report this comment

    Bad Form

    Tuesday, February 16, 2016

  • *correction, under TTIP a corporation can sue anyh government which introduces policies or legislation which impacts that corporation's profit. Tory rule = ruled by the corporations.

    Report this comment


    Tuesday, February 16, 2016

  • All is going to plan, then. This government *will* see the NHS privatised by hook or by crook. The TTIP agreement, which will make the whole privatisation process so much easier, is safely in place, having been discussed in absolute secrecy by our "democreatic" rulers and now a done deal. It's just a matter of time now before all those self-serving politicians and their chums can start monetising British suffering through lucrative out-sourcing deals with their off-shore chums. And thanks to TTIP, any corporation which stands to lose profit from government legislation, can be sued! SO there won't be any reversing it after the populace wake up to just what has been done to them. Thank heavens for the Tories and their endless mission to make the rich richer and the poor... irrelevent

    Report this comment


    Tuesday, February 16, 2016

  • All you Tory voters, well that's what you you wanted.... wasn't it?

    Report this comment

    St Mary's Road

    Tuesday, February 16, 2016

  • No Green Ink....there is a national shortage of Doctors as covered extensively in the media (locally Archant and Radio Norfolk etc)....too few bodies to fill all the 'spaces' they are needed! I learnt last week that there are 13 GP surgeries advertising for GP's in the Greater Norwich area, so this is another case of not having the skilled staff to fill the need. Comes back to us all using the services sensibly!......

    Report this comment


    Tuesday, February 16, 2016

  • It's the unsocial hours thing. You can have an excess of doctors overall but if very few are keen to work outside daytime Mon-Fri then you get what we see. The incentive has to be in the pay structure which clearly hasn't been done by government for a generation or two. If the daytime pay had been suppressed and the more inconvenient times been better rewarded I doubt we would be experiencing the present situation. Having allowed the situation to arise it will take years to address the problem.

    Report this comment

    Green Ink from Tunbridge Wells

    Tuesday, February 16, 2016

  • this is why a & e depts are so busy

    Report this comment


    Tuesday, February 16, 2016

  • When will the UK wake up!.....there is a drastic shortage of Doctors across all fields, and this is just another example! There are real shortages of GP's across all of the Uk, but especially in rural counties like Norfolk. Is it any surprise that Out of Hours service is experiencing what many Norfolk surgeries have apparently seen for years - a lack of being able to recruit GP's. We, the public, need to use the services less - if the capacity is limited, the demand also needs to be limited by us, to ensure the service is there when we really need it. I want to be able to see a GP when I really, really need to - but that means the minor stuff I have to deal with myself or by other means!

    Report this comment


    Tuesday, February 16, 2016

  • And how will dear Jeremy sort this one out? And is there any chance of the supported housing crisis being addressed too? Doubt it somehow.

    Report this comment


    Tuesday, February 16, 2016

  • I wonder if the many people who are struggling to get a doctors appointment end up in hospital due to a deterioration in their condition ?

    Report this comment

    John L Norton

    Tuesday, February 16, 2016

  • " IC24 said in its letter it was changing the staff’s skill mix from a GP workforce to a “broader skill mix best able to meet the needs of the patients”" What that means is delegating work to less skilledexperienced staff than GPs (whom they cant recruit) to best meet the needs of the shareholders. It stinks. This is what privatisation of the NHS means....minimum service levels and brecahing them becuase there is a lack of oversight

    Report this comment

    Stephen Strange

    Tuesday, February 16, 2016

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