Callers to out-of-hours GP services faced waits of more than 12 hours, posing a "significant risk to patient safety", a leaked report has revealed.
The interim report into Integrated Care 24 (IC24), which runs non-emergency 111 and out-of-hours services in Norfolk and Wisbech, found deficiencies in call handling and a shortage of GPs.
During unannounced inspections following complaints, staff said they had been asked to alter their records.
IC24 said it had addressed the issues.
The organisation operates NHS 111 services in areas including Great Yarmouth and Waveney and parts of Essex, and took over the Norfolk and Wisbech contract in September 2015.
'Element of fear'
Assessors from Norwich Clinical Commissioning Group (NCCG) inspected five IC24 bases in Norfolk and one in Cambridgeshire in November following staff complaints.
Their report highlighted issues including:
- An "emerging trend" of 111 callers waiting to be processed and an IT system that did not allow patients to be triaged effectively
- The call-handling system was "unclear for patients" with some "waiting in excess of 12 hours from their first contact which is clinically unsafe posing a significant risk to patient safety"
- Staff "asked to alter or not record accurately their contemporaneous notes"
- Staff said they had been unable to comply with requests, including "removing unseen patients from their screens in the morning and advised that a non-clinical member of staff had cleared the screen" of callers not dealt with
- "An element of fear" among staff over reporting concerns.
- A lack of GPs, having a "direct impact on the quality and clinical safety of the service" and on doctors themselves
- Staff concerns over "competency skills of individuals recruited to fill the GP shortfall"
- GPs unhappy at being consistently moved between bases to cover shortfalls
In October last year, IC24's interim chief executive said the organisation was still struggling to fill shifts.
A month later, Norwich resident Peter Rowley said he called 111 but waited 11 hours for a call back, eventually going to A&E instead.
The company apologised, but said it had followed procedures.
Karen Watts, who wrote the interim report into IC24, concluded it was "not clinically assured of the safety of the OOH [out-of-hours] service" and only "partially assured" of the 111 service.
She said the CCG believed the issues identified were having a "negative impact on recruitment and retention of the existing workforce".
Ms Watts also demanded IC24 provide a detailed improvement action plan by the beginning of December.
'No known deaths'
The BBC asked to see the improvement plan, and whether concerns highlighted in the report had been sufficiently addressed, but both NCCG and IC24 declined to answer, instead sending a joint statement.
NCCG spokesman Tim Curtis said the organisation had been "very encouraged with IC24's response".
Yvonne Taylor, IC24 chief executive, said: "As an open organisation, I would like to reassure our patients that we continue to work with our commissioners to provide a robust and transparent service for our patients."
Both organisations said: "There were no deaths that we know of which can be attributable to the long waits."
The NCCG has been asked to share the outcomes of its investigation so they could be examined by a health committee, a Norfolk County Council spokeswoman said.
Tony Durcan from the Royal College of Nursing said it had "sought reassurances that measures had been put in place to address the worrying points raised by the leaked report".
Dr Tim Morton, chairman of Norfolk and Waveney Local Medical Committee, said IC24's problems were "a consequence of a severe workforce crisis within the NHS in recruiting and retaining GPs".
NHS 111/Out-of-hours care
- 111 is the NHS non-emergency number for urgent but non life-threatening situations
- The service was launched nationwide in 2013 to replace NHS Direct
- 111 calls are recorded and advisers, supported by nurses and paramedics, "triage" callers needing medical help to an out-of-hours centre or A&E
- In 2014 a Care Quality Commission review of GP out-of-hours care concluded it was improving but was suffering from a lack of GPs
- In September 2015 a whistleblower working at a 111 call centre in Derby said it was "dangerously understaffed"