Out-of-hours concerns highlighted in Southern Health Trust report
An out-of-hours GP who works in Craigavon Area Hospital has described it as like "walking into hell".
The comments are in a confidential report into out-of-hours GP services in the Southern Health Trust.
Seen by the BBC, the report highlights patient safety concerns and describes a culture of "threats and harassment".
The trust said it was reviewing the service which had been "under increasing pressure this year".
The information in the report was provided by 32 out-of-hours doctors who participated in a series of workshops aimed at gauging opinion and morale among staff.
Participants, who remain anonymous, described staffing as a "catastrophe" while cutting services in Newry and Craigavon was said to be "unmanageable and dangerous".
The highly critical report describes a real lack of leadership across the out-of-hours service with little consultation with doctors and a lack of vision for the future.
It also describes management as being "remote" and "unapproachable".
Too few doctors filling shifts is clearly an issue, while others allege some are being paid an "enhancement" to work at short notice.
Maureen Ruddy took her grandchild to the GP out-of-hours service.
"If had taken him to Accident & Emergency, I would have had to wait five or six hours as well," she said.
"So the whole system seems to be stretched and there doesn't seem to be continuity of care any more."
A spokesperson for the Southern Trust said: "Action has already been taken to address issues with the delivery of the service including on-going recruitment for GPs, flexible working arrangements and enhanced payment rates for difficult-to-fill shifts, and the phased introduction of skilled nurses including advanced nurse practitioners.
"The trust has also run a series of workshops, open to all staff in the GP out-of-hours service, and through which staff were encouraged to share their views on the service now, and how it might best be managed and run in future.
"This confidential report was only recently completed, and has raised areas of concern that are being addressed as a matter of urgency by senior staff.
"We take all views of the service extremely seriously, and are committed to working with all staff in looking at changes needed, and working through the suggestions and recommendations which were discussed at the workshop."
In an accompanying letter to those who took part, the facilitator reminds staff that the workshops were held in private and the information should remain confidential.
The report, which was leaked to the BBC, said the workshops provided a forum for participants and the facilitator to challenge each other.
It also allowed those who took part to explore assumptions and perceptions about the work they do.
The report however makes embarrassing reading for health trust managers.
Among the criticisms was that too much emphasis on targets led to the creation of bad behaviours.
Also morale was very low, with many staff saying they just keep their heads down as "it's pointless trying to communicate their opinions to management as they would not be listened to".
The most serious allegation points to "bullying culture and a blame culture".
While more than 200 doctors work in the area, 32 took part in the workshops.
The report's author said a "large" number of participants talked about experiencing threats and harassment.
GPs also talked about a "loss of ownership" of the service and said they had little say in how it was run.
Despite the blistering attack, some of those who took part told the BBC that they were disappointed with the final report.
One GP said: "It has been watered down. It doesn't really convey the sense of anger we share about how we've been treated. The service has been run down into the ground."
There are five out-of-hours centres in the Southern Trust area.
There are two satellite (smaller) centres in Armagh and Kilkeel with others in Dungannon, Craigavon and Newry.
Services have been reduced in Armagh and Kilkeel, and the BBC understands there are to be further cuts.Misconception
While there are problems across the health service in recruiting doctors, the problem appears acute in the Southern Trust area.
Another GP in the area told the BBC that there was a misconception among those in charge that people did not get sick at the weekends.
"They are reducing hours and the number of out-of-hours GPs, but then at the last minute they are trying to get people to fill shifts in areas. We waste more time ringing round trying to get doctors when we could be seeing patients. The whole system is just badly managed there is no forward planning."
When asked by the BBC why a small proportion of doctors had taken part in the workshops the same doctor said there was a feeling the workshops were just a box-ticking exercise and a waste of time.
"No-one listens. We are fed up complaining. Then when you do - things happen. You aren't asked back. This is the health service now in Northern Ireland. It's just about making cuts and saving money."
However some doctors allege that in order to cover weekend shifts the trust is paying certain GPs extra to ensure rotas are covered.
The report said: "The inequity in the service is where GPs covering shifts at the last minute are paid an enhancement, but no-one else is."
Among the wide-ranging recommendations was exploring the possibility of having more salaried GPs in the service; developing strict criteria for using the out-of-hours service, and making each of the three areas responsible for looking after their own patients.
A spokesperson for the trust said it was extremely disappointed that the report had been leaked to the BBC as there was an understanding the process was confidential.