| HealthBoard | Headcount | TotalHours |
|---|---|---|
| NHS Ayrshire & Arran | 137 | 38,528 |
| NHS Borders | 33 | 6,385 |
| NHS Dumfries & Galloway | 40 | 12,448 |
| NHS Fife | 85 | 19,318 |
| NHS Forth Valley | 62 | 9,205 |
| NHS Grampian | 115 | 52,073 |
| NHS Greater Glasgow & Clyde | 356 | 90,399 |
| NHS Highland | 283 | 133,681 |
| NHS Lanarkshire | 131 | 37,093 |
| NHS Lothian | 238 | 54,360 |
| NHS Orkney | 15 | 9,178 |
| NHS Shetland | 16 | 5,342 |
| NHS Tayside | 150 | 74,271 |
| NHS Western Isles | 49 | 19,091 |
| Total | 1,577 | 561,372 |
Primary Care Out of Hours Workforce Survey 2024
1 Executive Summary
During the year ending 31 March 2024:
- The number of GPs working in Primary Care Out of Hours (OOH) services was 1,577. This is an increase from the 2023 survey of 48 (3.1%). The total hours worked over the year has increased by 7.1% to 561,372 hours.
- Approximately 10% of GPs working in OOH services worked approximately 45% of the total hours recorded. This was in keeping with the previous years survey.
- The OOH workforce was 53% female, although male GPs were recorded as providing 56% of the total GP hours worked.
- The average weekly input to services was 6.8 hours for all GPs, a slight increase from 6.6 hours the previous year.
- The average weekly input was 8.6 hours for male GPs and 5.1 for females. Older GPs tend to work more weekly hours in OOH services than younger GPs.
- The number of nurses working in OOH services was 331, working a total of 300,371. The headcount has decreased from the 2023 survey by 23, although the number of hours over the year increased by 33,058 hours.
- Most nurses working in OOH services are Band 7 (54%).
- 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.
- Most NHS Boards reported that not all shifts were filled as planned for shifts in the year ending 31 March 2024.
2 Introduction
This publication from NHS Education for Scotland (NES) presents results from the 2024 Primary Care Out of Hours (OOH) Workforce Survey which has been designed to capture information from the Primary Care OOH services in each NHS Board area. The survey is designed to give an evidence base for workforce planning for OOH services.
The Out of Hours Survey was last carried out in 2023. Results of surveys prior to 2023 were published by Public Health Scotland (PHS), and the results of earlier surveys can be found on PHS’s website.
The report provides information on:
- General Practitioners (GPs) and nurses working in Primary Care OOH services in the past year
- Challenges and experiences in filling shifts in the past year
- Use of multi-disciplinary teams within OOH
This survey has been developed 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.
More detailed information can be found within the supplementary data tables and dashboard published alongside this report.
Background information, including an overview of the data sources used and a glossary can be found on our website.
OOH activity data is published by PHS.
3 Results
3.1 Data quality
All 14 NHS Boards responded to the survey, however, not all provided complete data on staff age, sex and registration numbers.
Data quality improved for the 2024 survey compared to the 2023 survey, with only a few missing registration numbers missing. There was a still significant number of staff with missing age and gender.
| Staff Group | Registration Number | Age | Sex |
|---|---|---|---|
| Doctor | 0.4% | 80.8% | 46.5% |
| Nurse | 0.6% | 8.0% | 0% |
National Primary Care Clinicians Database (NPCCD) was used to look up age and sex where it was missing using Registration numbers to link the two datasets.
3.2 General Practitioners
3.2.1 Headcount and total hours
Table 2 presents GP headcount and total hours worked excluding GP Specialty trainees.
The number of GPs working in Primary Care OOH services during the year ending 31 March 2024 was 1,577, working a total of 561,372.0 hours. There was a slight increase in the total headcount and total hours worked across Scotland.
In previous reports, GP WTE was 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. This year we have revised our methodology to only report total hours.
Average hours per week is calculated based on a 52 week year.
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.
Table 3 shows the change in GP numbers between the 2023 and 2024 surveys.
Figure 1 and Figure 2 show changes in reported headcount and total hours figures in each Board between the 2023 and 2024 surveys.
| HealthBoard | Headcount 2023 | Headcount 2024 (Percentage Change) | Total Hours 2023 | Total Hours 2024 (Percentage Change) |
|---|---|---|---|---|
| NHS Ayrshire & Arran | 120 | 137 (14.2%) | 35,104 | 38,528.0 (9.8%) |
| NHS Borders | 40 | 33 (-17.5%) | 9,625 | 6,385.0 (-33.7%) |
| NHS Dumfries & Galloway | 48 | 40 (-16.7%) | 14,186 | 12,448.0 (-12.3%) |
| NHS Fife | 83 | 85 (2.4%) | 25,789 | 19,318.3 (-25.1%) |
| NHS Forth Valley | 34 | 62 (82.4%) | 6,755 | 9,204.9 (36.3%) |
| NHS Grampian | 120 | 115 (-4.2%) | 58,274 | 52,072.6 (-10.6%) |
| NHS Greater Glasgow & Clyde | 325 | 356 (9.5%) | 90,348 | 90,399.2 (0.1%) |
| NHS Highland | 237 | 283 (19.4%) | 106,720 | 133,681.1 (25.3%) |
| NHS Lanarkshire | 130 | 131 (0.8%) | 36,550 | 37,092.9 (1.5%) |
| NHS Lothian | 245 | 238 (-2.9%) | 57,164 | 54,360.0 (-4.9%) |
| NHS Orkney | 13 | 15 (15.4%) | 9,244 | 9,178.0 (-0.7%) |
| NHS Shetland | 23 | 16 (-30.4%) | 6,012 | 5,342.0 (-11.1%) |
| NHS Tayside | 159 | 150 (-5.7%) | 52,293 | 74,270.8 (42%) |
| NHS Western Isles | 49 | 49 (0%) | 15,849 | 19,091.0 (20.5%) |
| Total | 1529 | 1,577 (3.1%) | 523,913 | 561,372.0 (7.1%) |
3.2.2 Age and gender
Figure 3 displays GP headcounts by age group and sex.
There were more female GPs than male GPs (53.1% compared to 43.6%) in the OOH workforce.
3.2.3 Input to services
Table 4 presents the distribution of hours worked by GPs in the year ending 31 March 2024.
The figures below are shown in total hours over the year, for context 1000hrs over the year is an average of approximately 20hrs per week.
| Hours per year | Year | Number of GPs | % of GPs | Total hours worked in year | % of total hours |
|---|---|---|---|---|---|
| Under 50 | 2024 | 470 | 30% | 10,464.4 | 1.9% |
| 50-99 | 2024 | 206 | 13% | 14,774.0 | 2.6% |
| 100-199 | 2024 | 225 | 14% | 32,018.7 | 5.7% |
| 200-499 | 2024 | 303 | 19% | 97,491.7 | 17.4% |
| 500-999 | 2024 | 213 | 14% | 157,161.3 | 28.0% |
| 1,000-1,499 | 2024 | 81 | 5% | 98,420.0 | 17.5% |
| 1,500 and over | 2024 | 76 | 5% | 151,042.0 | 26.9% |
| Not stated | 2024 | 3 | 0% | 0.0 | 0.0% |
| Total | 2024 | 1,577 | 100% | 561,372.0 | 100.0% |
In keeping with previous surveys, approximately 10% of GPs working in OOH services are working approximately 45% of the total hours recorded (over 1000 hours per year each). In contrast, just under a third of GPs were recorded working fewer than 50 hours throughout the year; these GPs accounted for less than 2% of the total hours worked by all GPs.
Although there were more female GPs working in out of hours services in age groups under 55 years old, male GPs were recorded as working more hours across all age groups.
Male GPs provided 54.8% of the total GP input to services. This appears to continue the slight decrease seen in the last year (57.5%), but the sex of 5.4% of GPs was not known, which may affect this estimate slightly.
Average Weekly Hours Worked in OOH services
The mean weekly hours of all GPs was 6.85, up slightly on the previous year (6.59).
The mean weekly hours was 8.61 for male GPS and 5.13 for females. (The mean for the remaining GPs with unknown sex was 11.07).
Figure 5 shows older GPs work more weekly hours than younger GPs and male GPs work more weekly hours than female GPs in the same age group.
Figure 6 compares average GP weekly hours input to OOH services reported in the 2023 and 2024 surveys. The average number of hours worked by GPs is slightly higher in more rural NHS Boards such as NHS Highland and NHS Orkney. Although this might be due to differences in service delivery, where some GP hours are based on “on-call” hours rather than hours worked in clinics, particularly in rural areas.
There was variation across NHS Boards in terms of whether they reported an increase or a decrease in average GP input.
3.3 Nurses
3.3.1 Headcount and Whole Time Equivalent
The following sections present 2024 data on nurses providing input to OOH services in NHS Boards in Scotland.
In previous reports, Nurse WTE was based on total contracted hours over the year, divided by 46 working weeks in the year, divided by 37.5 working hours in the week. As with GPs, we have revised our methodology to only report total hours.
Figure 7 and Figure 8 present headcount and total hours figures for the 2023 and 2024 surveys, Table 5 shows the scale of any change between the two surveys.
| HealthBoard | Headcount 2023 | Headcount 2024 (Percentage Change) | Yearly Total Hours 2023 | Yearly Total Hours 2024 (Percentage Change) |
|---|---|---|---|---|
| NHS Ayrshire & Arran | 7 | 5 (-28.6%) | 4551.25 | 3207.91 (-29.5%) |
| NHS Borders | 19 | 17 (-10.5%) | 14780.96 | 16352.58 (10.6%) |
| NHS Dumfries & Galloway | 4 | 5 (25%) | 724.60 | 1587.55 (119.1%) |
| NHS Fife | 42 | 42 (0%) | 54905.02 | 54133.12 (-1.4%) |
| NHS Forth Valley | 14 | 23 (64.3%) | 8073.25 | 33869.2 (319.5%) |
| NHS Grampian | 45 | 39 (-13.3%) | 31750.75 | 32309.6 (1.8%) |
| NHS Greater Glasgow & Clyde | 47 | 51 (8.5%) | 35728.25 | 27419.75 (-23.3%) |
| NHS Highland | 51 | 36 (-29.4%) | 46670.50 | 40981.5 (-12.2%) |
| NHS Lanarkshire | 37 | 37 (0%) | 17173.69 | 18805.44 (9.5%) |
| NHS Lothian | 61 | 47 (-23%) | 31328.17 | 53281.38 (70.1%) |
| NHS Orkney | 4 | 7 (75%) | 484.00 | 514 (6.2%) |
| NHS Shetland | 3 | 4 (33.3%) | 472.50 | 1601 (238.8%) |
| NHS Tayside | 12 | 10 (-16.7%) | 13587.00 | 10053 (-26%) |
| NHS Western Isles | 8 | 9 (12.5%) | 7083.00 | 6255 (-11.7%) |
| Total | 354 | 331 (-6.5%) | 267312.94 | 300371.03 (12.4%) |
There was a slight decrease in the total headcount of OOH nurses, however the total hours increased, mainly driven by NHS Lothian. The overall changes are small, and especially in smaller boards any changes in headcount or total hours may result in large percentage changes.
3.3.2 Age and gender
Caution is advised when referring to comparing figures here with previous years details as the proportion of missing values was much higher in previous surveys.
Figure 9 shows the distribution of male and females nurses across age groups.
3.3.3 Agenda for Change (AfC) band
Figure 10 shows the percentage of nurses in each AfC band in 2024 and 2023.
There was very little change in the makeup of the Band profile of the OOH Nurse workforce.
3.3.4 Input to services
Table 6 shows nurses working in 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 | 21 | 6.3% | 566.00 | 0.2% |
| 50-99 | 15 | 4.5% | 1019.91 | 0.3% |
| 100-199 | 23 | 6.9% | 3587.31 | 1.2% |
| 200-499 | 57 | 17.2% | 19372.42 | 6.4% |
| 500-999 | 53 | 16.0% | 40449.17 | 13.5% |
| 1,000-1,499 | 96 | 29.0% | 120940.70 | 40.3% |
| 1,500 and over | 66 | 19.9% | 114435.52 | 38.1% |
| Total | 331 | 100.0% | 300371.03 | 100.0% |
Almost 50% of nurses are providing around 80% 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.
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 NHS Boards.
Out of the 14 territorial NHS Boards, 11 indicated that they used additional clinical roles within their OOH service.
Table 7 shows which roles are in the MDT in each of these NHS Boards.
| HealthBoard | HealthCareSupportWorker | Paramedic | MentalHealthWorker | Pharmacist | Other |
|---|---|---|---|---|---|
| NHS Ayrshire and Arran | No | No | No | No | 0 |
| NHS Borders | Yes | Yes | No | No | 0 |
| NHS Dumfries and Galloway | Yes | Yes | No | Yes | 0 |
| NHS Fife | Yes | Yes | No | No | 0 |
| NHS Forth Valley | Yes | Yes | No | No | 0 |
| NHS Grampian | Yes | No | Yes | No | 0 |
| NHS Greater Glasgow and Clyde | Yes | No | No | No | Yes |
| NHS Highland | No | Yes | No | No | 0 |
| NHS Lanarkshire | Yes | Yes | Yes | Yes | 0 |
| NHS Lothian | Yes | No | No | No | 0 |
| NHS Orkney | No | No | No | No | No |
| NHS Shetland | No | No | No | No | 0 |
| NHS Tayside | Yes | Yes | No | No | Yes |
| NHS Western Isles | No | Yes | No | No | Yes |
| Total | 9 | 8 | 2 | 2 | 3 |
Healthcare Support Worker was the most common role, reported by nine NHS Boards. Within three of the nine NHS Boards they were used for all shifts, and more than 50% of shifts by six of them.
Paramedic was the next most common role, reported by eight NHS Boards, but typically used for less than 25% of shifts.
The survey also asked about support from other clinical staff, such as Advanced Nurse Practitioners, who were not directly employed, managed or contracted by the OOH service. Four NHS Boards reported using support from this group.
Full details of MDT support can be found in the supplementary tables accompanying this report.
3.5 Managing the Out of Hours service
All 14 NHS Boards reported that not all shifts were filled during the survey period.
NHS Boards reported varying experiences in filling shifts, with some reporting considerable challenges, and others reporting a stable service or an improvement since the 2023 survey. Full commentary on each NHS Boards experience of filling shifts can be found in the data tables accompanying this report.
Ayrshire & Arran did not respond to the questions on Stand By Frequency.
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 unfilled 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.
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.
Actions included:
Using Stand By or back up cover
Reduced Triage Cover
Increase Financial incentives
Nurse filling a GP shift
GP filling a Nurse shift
Longer shifts
Reducing the number of locations used to deliver OOH services
Any Other actions boards took not otherwise classified
Ten Boards reported using longer shifts (four reported the use of longer shifts on a weekly basis). Four Boards reported using additional financial incentives to fill shifts (a fall from 7 the previous year), and none used more frequently than monthly. Similar to last year 9 Boards reported having Nurses cover GP shifts at varying frequencies (although only 2 Boards specifying this was done weekly, down from 4 the previous year).
Overall it appears that Boards had to take less actions than last year. This is bourne out in the general comments which can be found in the accompanying data tables.
| HealthBoard | 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 and Arran | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| NHS Borders | No | No | Yes: Quarterly | Yes: Quarterly | Yes: Biannually | Yes: Monthly | No | Remote GP Support: Quarterly |
| NHS Dumfries and Galloway | No | No | No | No | No | No | No | 0 |
| NHS Fife | No | No | No | Yes: Weekly | Yes: Quarterly | Yes: Weekly | No | 0 |
| NHS Forth Valley | Yes: Weekly | No | Yes: Biannually | No | Yes: Monthly | Yes: Monthly | Yes: Monthly | 0 |
| NHS Grampian | No | Yes: Monthly | No | Yes: Weekly | Yes: Weekly | Yes: Weekly | Yes: Monthly | 0 |
| NHS Greater Glasgow and Clyde | Yes: Quarterly | Yes: Quarterly | No | Yes: Quarterly | No | Yes: Quarterly | Yes: Quarterly | 0 |
| NHS Highland | No | Yes: Quarterly | Yes: Monthly | Yes: Monthly | Yes: Monthly | Yes: Quarterly | Yes: Monthly | 0 |
| NHS Lanarkshire | Yes: Weekly | No | No | Yes: Quarterly | No | Yes: Weekly | Yes: Weekly | 0 |
| NHS Lothian | No | No | Yes: Quarterly | Yes: Monthly | Yes: Monthly | Yes: Weekly | Yes: Monthly | 0 |
| NHS Orkney | No | No | No | Yes: Biannually | No | No | No | Short notice agency / locum: Biannually |
| NHS Shetland | No | No | No | No | No | No | No | 0 |
| NHS Tayside | No | No | No | No | No | Yes: Monthly | Yes: Quarterly | 0: Monthly |
| NHS Western Isles | No | Yes: Quarterly | No | Yes: Annually | No | Yes: Quarterly | No | Split shift: Annually |
| Total | 3 | 4 | 4 | 9 | 6 | 10 | 7 | 0 |
3.5.2 Standby / On-call / Back-up
Three Boards reported that they had standby, on-call or back-up arrangements in place for GPs for their Primary Care OOH service. NHS Forth Valley and NHS Lanarkshire were able to fill 100% of these shifts.
4 Appendices
4.1 Appendix 1: Official statistics information
As a provider, we adhere to the Code of Practice for Statistics and are regulated by the Office for Statistics Regulation. You can find more information on the Code of Practice, our protocols for Early and Pre-release Access to our publications, reports on events impacting our publications, our publication timetable.
4.1.1 Pre-release access to official statistics
Under terms of the “Pre-Release Access to Official Statistics (Scotland) Order 2008”, NES is obliged to publish information on those receiving Pre-Release Access (“Pre-Release Access” refers to statistics in their final form prior to publication). The standard maximum Pre-Release Access is five working days.
Named individuals in the following organisations are approved to receive standard Pre-Release Access:
- Scottish Government Primary Care Directorate
- NHS Board Chief Executives
- NHS Board Communication leads