• Manager at out of hours provider IC24 warned services were unsafe
  • Two doctors were responsible for covering a population of over 1.4 million overnight
  • Provider said it reviewed the incident and it currently exceeds its obligations on staffing levels

A manager warned that a GP out of hours provider was “unsafe” after just two doctors were responsible for covering a population of over 1.4 million overnight, a leaked email has revealed. 

In an email to senior managers concerning the service in Kent during a weekend in September, service delivery manager Lesley Williams said: “Having seen the screen myself this morning I need to let you know that the service is currently unsafe and has been overnight. We had two GPs and one [advanced nurse practitioner] in East Kent and two ANPs in West Kent overnight.”

Out of hours cover is provided by social enterprise IC24, which also provides services in Sussex, Norfolk, Suffolk, Essex and Northamptonshire.

Ms Williams’ email was sent at 8am, when the service across all of Kent, except Swale and Medway, had 130 people waiting for advice, 67 waiting to be seen at bases and nine visits to make. This included at least two palliative care patients in West Kent, one of whom was described as “actively dying” and waited six and a half hours for a visit.

The GPs in East Kent – who were also caring for some very poorly patients – had to decide which patients should have priority for visits, according to the email.   

Another non-palliative patient was listed for a visit after the service was contacted at 1pm on 8 September, but this did not happen until 6.15am the following day, partly due to a clerical error.

Ms Williams continued that she was unsure whether there was going to be a clinician based at Maidstone that morning, she anticipated there would be no clinical cover in the afternoon in Canterbury – either at the base or visiting patients – and there would be no doctor based at Dover or Margate that evening. IC24 told HSJ that mobile clinicians and other bases covered these gaps. 

“The overnight staff are quite upset as they are being called constantly chasing callbacks by paramedics and 111 because we are failing to contact patients, due to lack of clinical staff,” Ms Williams concluded.

In a statement, IC24 said it was currently exceeding its obligations on staffing levels, and has contingency plans when staffing is “lower than desired”.  

“These include moving staff according to demand, and staffing fluctuation. On a weekly basis we assess issues such as the longest waits patients experienced, assess the potential impact on those patients, and report back to our clinical commissioning groups, with whom we have close working relationships to ensure quality of service,” it said. The service had planned to have a GP in West Kent overnight but this shift had not been filled.

“The delays experienced by two palliative care patients in North and West Kent during the weekend of 8-9 September have been reviewed to ensure that no harm was caused to the patients as a result,” the statement added. Staff were encouraged to report incidents they considered unsafe and these are investigated by a senior clinician, it said.

A spokesman for West Kent CCG and the four east Kent CCGs said: “The CCGs monitor the performance of the out of hours’ provider daily, along with weekly reports. There have been no serious incidents reported.

“Where a gap in workforce is identified, for instance through sickness, the provider puts contingency plans into place. This means that patients will continue to have access to health professionals when they need it.”