Primary Care Out of Hours Workforce Survey 2023
NHS Education for Scotland
12 December 2023
1 Executive Summary
- The number of GPs working in Primary Care out of hours (OoH) services during the year ending 31 March 2023 was 1,530, equivalent to a whole time equivalent (WTE) of 284.7. Most boards reported an increase in GP numbers from the 2022 survey.
- In keeping with the 2021/22 survey’s findings, approximately 10% of GPs working in OoH services are working approximately 45% of the total hours recorded.
- Similar to the 2022 survey, male GPs were recorded as providing 58% of the total GP input to services.
- The average weekly input to services was 6.59 hours for all GPs, 8.49 hours for male GPS and 4.88 for females. Older GPs tend to work more weekly hours in OoH services than younger GPs.
- The number of nurses working in Primary Care out of hours (OoH) services during the year ending 31 March 2023 was 354, equivalent to a WTE of 155.
- Since the previous survey there has been an increase in the percentage of Agenda for Change Band 6 nurses and a decrease in the percentage of Band 7 nurses working in OoH services.
- Healthcare Support Worker was the most common multidisciplinary team role in OoH services, reported by nine Boards in total and being used for either all shifts or more than 50% of shifts by six of them.
- All 14 Boards reported that, for shifts that were filled in the year ending 31 March 2023, not all shifts were filled as planned. Five Boards report the use of longer shifts on a weekly basis to deal with unfilled shifts. Nine Boards reported having Nurses cover GP shifts, with two reporting that this occurred weekly.
2 Introduction
This publication from NHS Education for Scotland (NES) presents results from the 2023 Primary Care Out of Hours Workforce Survey which has been designed to capture information from the Primary Care Out of Hours services in each NHS Board area. The survey is an important source of information to support workforce planning for Primary Care Out of Hours (OoH) services. The results of previous surveys have been published by Public Health Scotland (PHS), and the results of earlier surveys can be found on PHS’s website
The report provides information including:
- General Practitioners (GPs) and nurses working in Primary Care Out of Hours services in the past year
- Challenges and experiences in filling shifts in the past year
- Use of multi-disciplinary teams within Out of Hours
This survey has been developed over recent years in partnership with a range of stakeholders including: the Scottish General Practitioners’ Committee, the Royal College of General Practitioners, the Royal College of Nursing and the Scottish Practice Nurse Association.
Much of the information presented in this report is for Scotland as a whole, although some figures are also shown by NHS Board. More detailed information for individual NHS Boards is provided within the supplementary data tables published alongside this report.
3 Results
3.1 Response rates and data quality
All 14 boards responded to the survey. However, not all boards provided complete data. Data on staff age, sex and registration numbers were affected by missingness.
NHS Forth Valley and NHS Ayrshire & Arran did not provide registration numbers for doctors. This has the potential to cause an over-estimate in doctor headcount, as registration numbers are used to identify unique individuals working in more than one board. However, an examination of the likelihood of a doctor working in more than one board suggests that the overall impact will very small if we assume all GPs in NHS Forth Valley and NHS Ayrshire & Arran are unique individuals in the total survey data set.
NHS Tayside did not provide working hours data for around 22% of their GPs. These GPs will still be included in headcount calculations, but the missing data will result in an underestimate of GP WTE in this board. These GPs will also be excluded from measures of average input to OoH services in this board and nationally.
Three boards (NHS Tayside, NHS Western Isles and NHS Greater Glasgow and Clyde) did not provide usable sex data for their GPs.
For GPs, age data was only 25% complete. Rather than fail to report age statistics this year, we have used the GP registration numbers provided in the survey data to link to centrally-held data on GPs that contains information on age and sex. Data from the National Primary Care Clinicians Database (NPCCD) is used in both the the In-Hours primary Care Workforce Survey and the Annual GP Headcount publications. For this linkage we have used the NPCCD extract that was used to support the In-Hours survey as it relates to the appropriate survey census date. This NPCCD extract was also used to look up sex information for the boards who did not provide it for GPs. The linkage was not 100% complete and so we report age and sex categories of “not known” where appropriate.
3.2 General Practitioners
3.2.1 GP Headcount and Whole Time Equivalent (WTE)
3.2.1.1 National GP headcount and WTE
Table 1 presents headcount and WTE totals for OoH services in each board.
The data presented here excludes Specialist Trainee GPs (GPSTs). Numbers of GPSTs working in OoH services can be found in the accompanying data tables.
| Board | Headcount | WTE |
|---|---|---|
| Ayrshire & Arran | 120 | 19.1 |
| Borders | 40 | 5.2 |
| Dumfries & Galloway | 48 | 7.7 |
| Fife | 83 | 14.0 |
| Forth Valley | 34 | 3.7 |
| Grampian | 120 | 31.7 |
| Greater Glasgow & Clyde | 325 | 49.1 |
| Highland | 237 | 58.0 |
| Lanarkshire | 130 | 19.9 |
| Lothian | 245 | 31.1 |
| Orkney | 13 | 5.0 |
| Shetland | 23 | 3.3 |
| Tayside | 159 | 28.4 |
| Western Isles | 49 | 8.6 |
| Total | 1,530 | 284.7 |
The number of GPs working in Primary Care OoH services during the year ending 31 March 2023 was 1,530, equivalent to a Whole Time Equivalent (WTE) of 284.7. Most boards reported an increase in GP numbers from the 2022 survey.
In this report, GP WTE is based on total contracted hours over the year, divided by 46 working weeks in the year, divided by 40 working hours in the week. WTE is a relatively artificial concept in relation to Primary Care OoH services, as staff are unlikely to be employed on a whole-time basis within the service. However, it is useful as a general guide in informing workforce planning as WTE is used widely in other reporting on the NHS workforce.
Due to differences in the ways in which Primary Care OoH services are delivered in different geographical settings, hours recorded for GPs in some rural areas may be based on “on-call” hours rather than hours worked in clinics.
The Table 2 is a guide to relative change in GP numbers between the 2022 and 2023 surveys.
The 2022 survey report drew attention to missing data in NHS Borders and NHS Highland, and changes in service coverage in NHS Orkney. GP numbers reported for NHS Western Isles in 2022 were also unusually low compared with previous surveys, resulting in an unusually high relative increase this year. The WTE for NHS Tayside in 2023 will be affected by their missing working hours data. Care should therefore be taken when making comparisons between the 2022 and 2023 surveys for these boards and for the national total.
| Board | Headcount 2022 | Headcount 2023 | Headcount % change | WTE 2022 | WTE 2023 | WTE % change |
|---|---|---|---|---|---|---|
| Ayrshire & Arran | 119 | 120 | 1% | 16.2 | 19.1 | 18% |
| Borders | 40 | 5.2 | ||||
| Dumfries & Galloway | 31 | 48 | 55% | 6.9 | 7.7 | 12% |
| Fife | 48 | 83 | 73% | 11.2 | 14.0 | 25% |
| Forth Valley | 43 | 34 | -21% | 4.5 | 3.7 | -18% |
| Grampian | 125 | 120 | -4% | 24.7 | 31.7 | 28% |
| Greater Glasgow & Clyde | 317 | 325 | 3% | 39.6 | 49.1 | 24% |
| Highland | 202 | 237 | 17% | 42.6 | 58.0 | 36% |
| Lanarkshire | 101 | 130 | 29% | 16.4 | 19.9 | 21% |
| Lothian | 305 | 245 | -20% | 35.6 | 31.1 | -13% |
| Orkney | 14 | 13 | -7% | 5.6 | 5.0 | -11% |
| Shetland | 16 | 23 | 44% | 3.4 | 3.3 | -3% |
| Tayside | 141 | 159 | 13% | 23.2 | 28.4 | 22% |
| Western Isles | 4 | 49 | 1,125% | 2.3 | 8.6 | 274% |
| Total | 1,392 | 1,530 | 10% | 232.0 | 284.7 | 23% |
Figure 1 shows changes in reported headcount and WTE figures in each Board between the 2022 and 2023 surveys.
In the context of increases in headcount and WTE, there is some evidence that OoH activity has also increased. According to OoH activity data published by PHS, total consultations increased by 9.4% between March 2022 and March 2023.
3.2.1.2 GP headcount by sex and age
As discussed in the section on data quality, GP age and sex data were affected by missingness.
We have used the NPCCD data set that is used in both the in-hours workforce survey and the Headcount and List Size publication to look up the age group and sex where these have not been supplied. Where matching has not been possible - due to factors such as OoH GPs not appearing in the NPCCD extract, or incorrect registration numbers reported in the survey, we report “Not known” categories for GP age and sex.
Figure 2 displays GP headcounts by age group and sex
Based on the available GP sex data in 2023, female GPs made up a larger percentage of the OoH workforce than male GPs (53% compared to 45%).
The largest GP headcount was among female GPs aged 35-44 years.
Among GPs aged 55 and over, there were slightly more male GPs than female GPs in each age group.
3.2.2 Input to services
Table 3 presents the distribution of hours worked among GPs in the year ending 31 March 2023.
| Hours per year | Number of GPs | % of GPs | Total hours input | % of total hours |
|---|---|---|---|---|
| Under 50 | 463 | 30.26% | 9,665 | 1.84% |
| 50-99 | 204 | 13.33% | 14,735 | 2.81% |
| 100-199 | 214 | 13.99% | 31,349 | 5.98% |
| 200-499 | 267 | 17.45% | 87,975 | 16.79% |
| 500-999 | 197 | 12.88% | 139,918 | 26.71% |
| 1,000-1,499 | 82 | 5.36% | 101,029 | 19.28% |
| 1,500 and over | 68 | 4.44% | 139,241 | 26.58% |
| Not stated | 35 | 2.29% | 0 | 0.00% |
| Total | 1,530 | 100.00% | 523,913 | 100.00% |
In keeping with the previous survey’s findings, approximately 10% of GPs working in OoH services are working approximately 45% of the total hours recorded. (It must be borne in mind that, due to differences in the way in which Primary Care OoH services are delivered, some GP hours are based on “on-call” hours rather than hours worked in clinics, particularly in rural areas.)
Also similarly to the 2022 survey, around 30% of GPs where recorded working fewer than 50 hours throughout the year; these GPs accounted for less than 2% of the total hours worked by all GPs.
Among GPs reported as working 1,000 or more hours over the year, 65.3% were male and 31.3% were female (the sex of the remaining 3.3% of GPs was unknown).
Among this same group, 28.7% were aged between 35 and 44, and 27.3% were aged 45 to 54. The age group of 29 of GPs in this group was not known, but a comparison with the 2022 data on this group of GPs suggests that most would be at the upper end of the age distribution (55 and over).
Male GPs were recorded as providing 58% of the total GP input to services. This appears to be a slight decrease from last year (59%), but the sex of 3% of GPs was not known in 2023, which may affect this estimate slightly.
The mean weekly hours of all GPs was 6.59.
The mean weekly hours was 8.49 for male GPS and 4.88 for females. (The mean for the remaining GPs with unknown sex was 9.46)
Table 4 and Figure 3 show the distribution of mean weekly hours across sex and age categories. Figure 4 shows the distribution of GPs and total hours across GP age groups.
| Sex | Age group | Mean weekly hours |
|---|---|---|
| Female | Under 35 | 2.23 |
| Female | 35-44 | 4.31 |
| Female | 45-54 | 6.46 |
| Female | 55-59 | 6.86 |
| Female | 60-64 | 7.10 |
| Female | 65 and over | 10.13 |
| Female | Not known | 5.70 |
| Male | Under 35 | 5.10 |
| Male | 35-44 | 8.91 |
| Male | 45-54 | 9.52 |
| Male | 55-59 | 9.98 |
| Male | 60-64 | 11.02 |
| Male | 65 and over | 10.74 |
| Male | Not known | 8.25 |
| Not known | Not known | 9.46 |
The highest mean weekly hours are recorded for Males aged 60 and over, though mean weekly hours are comparably high for female GPs aged 65 and over. For both male and female GPs, the lowest mean weekly hours are recorded for doctors under 35 years old. On the whole, older GPs work more weekly hours than younger GPs.
Figure 5 compares average GP weekly hours input to OoH services reported in the 2022 and 2023 surveys.
The figures for Western Isles are affected by the unusually low figures reported in 2022. There was variation across Boards in terms of whether they reported an increase or a decrease in average GP input.
3.3 Nurses
3.3.1 Nurse Headcount and Whole Time Equivalent
The following sections present 2023 data on Nurses providing input to OoH services in NHS Boards in Scotland.
Unique identifiers were not supplied by NHS Ayrshire & Arran or NHS Forth Valley. Taking the same approach as with GPs and assessing likelihood of nurses working in more than one board based on the other data available, we expect a negligible impact of treating Nurses in NHS Ayrshire & Arran and NHS Forth Valley as unique individuals in the overall data set.
Table 5 and Figure 6 present headcount and WTE figures for the 2022 and 2023 surveys with indications of the scale of any change between the two surveys.
The 2022 survey report drew attention to missing data in NHS Borders and NHS Highland, and changes in service coverage in NHS Orkney. Care should therefore be taken when making comparisons between the 2022 and 2023 surveys for these boards and for the national total.
| Board | Headcount 2022 | Headcount 2023 | Headcount % change | WTE 2022 | WTE 2023 | WTE % change |
|---|---|---|---|---|---|---|
| Ayrshire & Arran | 10 | 7 | -30% | 4.4 | 2.6 | -41% |
| Borders | 19 | 8.6 | ||||
| Dumfries & Galloway | 5 | 4 | -20% | 0.7 | 0.4 | -43% |
| Fife | 41 | 42 | 2% | 24.4 | 31.8 | 30% |
| Forth Valley | 15 | 14 | -7% | 7.1 | 4.7 | -34% |
| Grampian | 39 | 45 | 15% | 16.6 | 18.4 | 11% |
| Greater Glasgow & Clyde | 49 | 47 | -4% | 20.7 | 20.7 | 0% |
| Highland | 31 | 51 | 65% | 12.2 | 27.1 | 122% |
| Lanarkshire | 52 | 37 | -29% | 9.3 | 10.0 | 8% |
| Lothian | 41 | 61 | 49% | 14.5 | 18.2 | 26% |
| Orkney | 0 | 4 | 0.0 | 0.3 | ||
| Shetland | 0 | 3 | 0.0 | 0.3 | ||
| Tayside | 11 | 12 | 9% | 7.2 | 7.9 | 10% |
| Western Isles | 0 | 8 | 0.0 | 4.1 | ||
| Total | 294 | 354 | 20% | 117.2 | 155.0 | 32% |
Several boards reported decreases between 2022 and 2023 but there was a large relative increase in NHS Lothian. The large increase in NHS Highland may be an artifact of NHS Highland being unable to submit a full data return in the 2022 survey.
3.3.2 Nurse age and gender
Three boards did not report age information for nurses: NHS Dumfries & Galloway, NHS Greater Glasgow & Clyde and NHS Shetland. Three other boards supplied incomplete age information for OoH nurses: Grampian (4% missing), Highland (14% missing) and Lanarkshire (70% missing). This limits what we can usefully present this year and some caution is advised when referring to figures here and in the accompanying data tables that involve age groups.
Figure 7 shows the distribution of male and females nurses across age groups.
3.3.3 Nurse headcount by Agenda for Change (AfC) band and Survey Year
Figure 8 shows the percentage of nurses in each AfC band in each survey since 2015
There was a small increase in the percentage of Band 6 nurses between the 2022 and 2023 surveys, from 21% to 26%. This was after three consecutive decreases since the 2015 survey. There was also a decrease in the percentage of Band 7 nurses after three consecutive increases, from 62% to 54%.
3.3.4 Nurse input to services
Table 6 shows nurse input to OoH services by number of hours worked throughout the year.
| Hours per year | Nurses (headcount) | Nurses (%) | Total hours input | Percentage of total hours |
|---|---|---|---|---|
| Under 50 | 35 | 9.89% | 787 | 0.29% |
| 50-99 | 20 | 5.65% | 1,465 | 0.55% |
| 100-199 | 40 | 11.30% | 5,745 | 2.15% |
| 200-499 | 67 | 18.93% | 23,005 | 8.61% |
| 500-999 | 54 | 15.25% | 41,673 | 15.59% |
| 1,000-1,499 | 80 | 22.60% | 98,662 | 36.91% |
| 1,500 and over | 53 | 14.97% | 95,975 | 35.90% |
| Not stated | 5 | 1.41% | 0 | 0.00% |
| Total | 354 | 100.00% | 267,313 | 100.00% |
Looking at nurses inputting 1,000 or more hours per year, we see that almost 40% of nurses are providing around 70% of the total input to OoH services.
3.4 Multi-disciplinary teams
The survey asked services for information about their use of wider multidisciplinary teams (MDTs) within their OoH provision.
Out of the 14 territorial Boards, 10 Boards indicated that they used additional clinical roles which were directly employed, managed or contracted by their OoH service.
Table 7 shows which roles comprise the employed/managed/contracted MDT provision in each of these 10 boards.
| Board | MDT roles used |
|---|---|
| NHS Borders | Healthcare Support Worker; Paramedic |
| NHS Dumfries & Galloway | Healthcare Support Worker; Paramedic |
| NHS Fife | Healthcare Support Worker; Paramedic |
| NHS Forth Valley | Healthcare Support Worker; Mental Health Worker; Paramedic |
| NHS Greater Glasgow & Clyde | Advanced Nurse Practitioner; Healthcare Support Worker; Other |
| NHS Highland | Healthcare Support Worker; Paramedic |
| NHS Lanarkshire | Healthcare Support Worker; Mental Health Worker |
| NHS Lothian | Healthcare Support Worker |
| NHS Tayside | Healthcare Support Worker; Other; Paramedic; Pharmacy Technician |
| NHS Western Isles | Advanced Nurse Practitioner; Other; Paramedic |
Healthcare Support Worker was the most common role, reported by nine Boards in total and being used for either all shifts or more than 50% of shifts by six of them. Paramedic was the next most common role, reported by seven Boards but typically used for less than 25% of shifts. The use of Pharmacy Technicians was reported by only one Board.
Multi-disciplinary staff were employed under a mixture of arrangements, some directly employed while others were contracted. Employment arrangements for the same role could differ across Boards.
The survey also asked about support from other clinical staff who were not directly employed, managed or contracted by the OoH service. Four Boards reported using support from this group. One Board - NHS Orkney - reported only having MDT input from this non-employed/managed/contracted group of Other Clinical Staff.
Full details of MDT support can be found in the supplementary tables accompanying this report.
3.5 Managing the Out of Hours service
Previous surveys have asked Boards about the estimated proportion of shifts that were successfully filled in the past year, and whether this represented an increase or decrease from the previous year. Unfortunately, this question was unintentionally omitted from the 2023 data collection tool and we are unable to report on this for the year ending March 2023.
All 14 Boards reported that, for shifts that were filled in the year ending 31 March 2023, not all shifts were filled as planned.
Boards reported varying general experiences in filling shifts, with some boards reporting considerable challenges, and others reporting a stable service or an improvement from the time of the 2022 survey. Full Board commentary on the experience of filling shifts can be found in the data tables accompanying this report.
3.5.1 Proportion of shifts unfilled 48 hours beforehand.
For GP shifts on normal weekdays, 12 Boards reported that less than a third of shifts were affected 48 hours beforehand, and two Boards reported no issue with these shifts. For weekend day shifts, NHS Borders and NHS Fife reported that about a third of shifts were affected, and NHS Forth Valley reported that more than two thirds were affected. NHS Fife reported issues with about half of weekend overnight shifts being unfilled 48 hours in advance.
Fuller details of affected shift types for all Boards, including Nurse shifts, are available in the data tables accompanying this report.
Table 8 details the additional actions reported by Boards when shifts could not be filled as planned, and the frequency with which each type of action was required in each Board.
Five Boards report the use of longer shifts on a weekly basis. Seven Boards report never using additional financial incentives to fill shifts. NHS Borders uses remote GP support on a quarterly basis and NHS Orkney has used Paramedic cover for some shifts. Nine Boards reported having Nurses cover GP shifts at varying frequencies (four Boards specifying this was done weekly).
| board | Standby / On-call / Back-up cover used | Reduced triage cover | Increased rates / financial incentives | Nurse filling GP shift | GP filling nurse shift | Longer shifts | Reduce number of bases | Other |
|---|---|---|---|---|---|---|---|---|
| NHS Ayrshire & Arran | Yes: Annually | No | No | No | No | Yes | Yes | |
| NHS Borders | No | No | Yes: Quarterly | Yes: Quarterly | Yes: Biannually | Yes: Monthly | No | Remote GP support: Quarterly |
| NHS Dumfries & Galloway | No | Yes: Monthly | No | No | No | No | No | |
| NHS Fife | No | No | Yes | Yes: Weekly | No | Yes: Weekly | No | |
| NHS Forth Valley | Yes: Weekly | Yes: Weekly | No | Yes: Monthly | No | |||
| NHS Grampian | Yes: Annually | No | No | Yes: Weekly | Yes: Weekly | Yes: Weekly | No | |
| NHS Greater Glasgow & Clyde | Yes: Monthly | Yes: Monthly | Yes: Monthly | Yes: Monthly | Yes: Quarterly | Yes: Weekly | Yes: Monthly | |
| NHS Highland | Yes: Quarterly | Yes: Monthly | Yes: Weekly | Yes: Monthly | Yes: Monthly | Yes: Monthly | Yes: Quarterly | |
| NHS Lanarkshire | No | No | No | Yes: Quarterly | No | Yes: Weekly | Yes: Weekly | |
| NHS Lothian | No | No | Yes: Quarterly | Yes: Monthly | Yes: Monthly | Yes: Weekly | Yes: Quarterly | |
| NHS Orkney | No | No | No | Yes: Quarterly | No | No | No | Paramedic cover |
| NHS Shetland | No | No | Yes: Biannually | No | No | No | No | |
| NHS Tayside | No | Yes: Quarterly | No | No | Yes: Quarterly | |||
| NHS Western Isles | No | Yes: Quarterly | No | Yes: Annually | No | Yes: Quarterly | No | Split shift: Annually |
3.5.2 Standby / On-call / Back-up
Only fours Boards reported that they had standby/on-call/back-up arrangements in place for GPs for their Primary Care OoH service. Only NHS Orkney reported being able to fill 100% of these shifts. NHS Forth Valley filled more than two thirds, NHS Grampian about half, and NHS Greater Glasgow and Clyde about a third.