More than a million people last year were left without urgent on-call GP cover on some weekends and nights because of a shortage of family doctors to staff out-of-hours services, an investigation found.

There were at least 146 urgent care shifts around the country in 2018 which did not have a single GP, a rise from 57 recorded last year though true numbers in both years are likely to be higher.

Hywel Dda Health Board which covers more than 384,000 patients spread across rural west Wales accounted for the majority of these.

However Tower Hamlets Clinical Commissioning Group (CCG), which spans 331,000 patients in East London, and North East Lincolnshire CCG, covering 129,000 patients, also struggled to find cover.

Doctors leaders said that a national shortage of GPs and daily pressures of routine general practice left many doctors unable to take on extra shifts.

Everyone the Government blames for the NHS crisis – except themselves Show all 6 1 /6 Everyone the Government blames for the NHS crisis – except themselves Everyone the Government blames for the NHS crisis – except themselves The elderly “We acknowledge that there are pressures on the health service, there are always extra pressures on the NHS in the winter, but we have the added pressures of the ageing population and the growing complex needs of the population,” Theresa May has said. Waits of over 12 hours in A&E among elderly people have more than doubled in two years, according to figures from NHS Digital. Getty Everyone the Government blames for the NHS crisis – except themselves Patients going to A&E instead of seeing their GPs Jeremy Hunt has called for a “honest discussion with the public about the purpose of A&E departments”, saying that around a third of A&E patients were in hospital unnecessarily. Mr Hunt told Radio 4’s Today programme the NHS now had more doctors, nurses and funding than ever, but explained what he called “very serious problems at some hospitals” by suggesting pressures were increasing in part because people are going to A&Es when they should not. He urged patients to visit their GP for non-emergency illnesses, outlined plans to release time for family doctors to support urgent care work, and said the NHS will soon be able to deliver seven-day access to a GP from 8am to 8pm. But doctors struggling amid a GP recruitment crisis said Mr Hunt’s plans were unrealistic and demanded the Government commit to investing in all areas of the overstretched health service. Getty Everyone the Government blames for the NHS crisis – except themselves Simon Stevens, head of NHS England Reports that “key members” of Ms May’s team used internal meetings to accuse Simon Stevens, head of NHS England, of being unenthusiastic and unresponsive have been rejected by Downing Street. Mr Stevens had allegedly rejected claims made by Ms May that the NHS had been given more funding than required. Getty Everyone the Government blames for the NHS crisis – except themselves Previous health policy, not funding In an interview with Sky News’s Sophy Ridge, Ms May acknowledged the NHS faced pressures but said it was a problem that had been “ducked by government over the years”. She refuted the claim that hospitals were tackling a “humanitarian crisis” and said health funding was at record levels. “We asked the NHS a while back to set out what it needed over the next five years in terms of its plan for the future and the funding that it would need,” said the Prime Minister. “They did that, we gave them that funding, in fact we gave them more funding than they required… Funding is now at record levels for the NHS, more money has been going in.” But doctors accused Ms May of being “in denial” about how the lack of additional funding provided for health and social care were behind a spiralling crisis in NHS hospitals. Getty Images Everyone the Government blames for the NHS crisis – except themselves Target to treat all A&E patients within four hours Mr Hunt was accused of watering down the flagship target to treat all A&E patients within four hours. The Health Secretary told MPs the promise – introduced by Tony Blair’s government in 2000 – should only be for “those who actually need it”. Amid jeers in the Commons, Mr Hunt said only four other countries pledged to treat all patients within a similar timeframe and all had “less stringent” rules. But Ms May has now said the Government will stand by the four-hour target for A&E, which says 95 per cent of patients must be dealt with within that time frame. Getty Images Everyone the Government blames for the NHS crisis – except themselves No one Mr Hunt was accused of “hiding” from the public eye following news of the Red Cross’s comments and didn’t make an official statement for two days. He was also filmed refusing to answer questions from journalists who pursued him down the street yesterday to ask whether he planned to scrap the four-hour A&E waiting time target. Sky News reporter Beth Rigby pressed the Health Secretary on his position on the matter, saying “the public will want to know, Mr Hunt”. “Sorry Beth, I’ve answered questions about this already,” replied Mr Hunt. “But you didn’t answer questions on this. You said it was over-interpreted in the House of Commons and you didn’t want to water it down. Is that what you’re saying?” said Ms Rigby. “It’s very difficult, because how are we going to explain to the public what your intention is, when you change your position and then won’t answer the question, Mr Hunt”. But the Health Secretary maintained his silence until he reached his car and got in. Getty

“We’re in a national recruitment crisis,” Dr Simon Abrams, a Liverpool GP and chair of Urgent Health UK, which represents out-of-hours providers, said.

“If you’ve got a day job there’s a lot of pressure that makes being available to do out-of-hours even less likely than it used to be.”

The findings come from analysis by Pulse, the publication for GPs, which made freedom of information requests to CCGs and health boards across England, Wales, Northern Ireland and Scotland.

They received 79 responses meaning the actual number of shifts uncovered by a GP could be higher, with nearly two thirds of CCGs and health boards failing to respond.

Staff shortages may also have contributed to the rise in serious incidents reported by GP out-of-hours providers in the past year.

These are recorded where avoidable mistakes put patients at risk or led to harm, and there were 108 reported across 44 CGs and health boards in 2018, a rise of a quarter from 84 serious incidents recorded in 2017.

Other areas in Wales also struggled to fill all their out-of-hours GP shifts. While in Scotland NHS Borders health board, which covers 115,000 patients, saw the number of unfilled shifts last year rise from two, in 2017, to eight.

Out-of-hours services provide GP appointments and urgent home visits for patients who may fall ill and need assessment or monitoring to avoid an A&E visit.

All GP surgeries were required to provide out of hours services until it became optional with the 2004 GP contract.

While the government has abandoned its pledge to recruit 5,000 more GPs by 2020 – after GP numbers fell instead – it has increased pressure in other ways.

A commitment that every patient would be able to access routine GP appointments on weekends and evenings has raised the prices for out of hours work, despite an earlier report showing many of these appointments going wasted.

This means out of hours providers are increasingly looking at how other staff can fill the gaps left by GPs, with many turning to paramedics or specialist nurses.

Joe Teape, chief executive of Hywel Dda Health Board, which accounted for 125 of the shifts with no GP, told Pulse: “This is a familiar trend among health boards and we are working together across different services to offer access to out-of-hours care.