Don’t blame GPs for out-of-hours failings

Michael Ingram,, 8th February 2010

Another day, another of the seemingly incessant attacks on “lazy, overpaid, inaccessible GPs”. There they sit, runs the mantra, enjoying their 9-5 days and handsome recompense while lives are put at risk every night and weekend through second-rate or dangerous out-of-hours service. It wasn’t like this in the old days

Of course it wasn’t. What could match the arrival of the avuncular doctor who, seemingly at your beck and call, would visit at all hours of the day and night? But in those days patients also died rapidly and prematurely of diabetes, heart disease or cancers. There were fewer elderly patients and very little monitoring or treating of long-standing conditions. Hospitals kept patients in for weeks until they were fully returned to health; there was no concept of day surgery or early discharge. Our consultations were short and the welter of paperwork, emails, telephone calls and meetings was absent.

These days though, the GP’s lot has changed. As we take the strain for the hospitals, the complexity and weight of our daily workload has changed irrevocably – yet we remain avuncular.

Before the much-maligned re-negotiation of the GP contract in 2004, I was doing all my own duties day and night and was just about coping. But only just. There was no day off after a night on duty. There was no shift system in place. I was exhausted. Yes, I had the satisfaction of helping those in distress but they were outnumbered by patients who would wake me up in the early hours to tell me that they could not sleep.

My colleagues were withering and morale in general practice was at rock bottom. New graduates would contemplate 24‑hour duty and walk away. It was a desperate situation.

Then we were relieved of out-of-hours care and it changed general practice for the better. Though many GPs still do work some shifts, it meant we were better able to cope with the core 10½-hour daily practice responsibility.

But even though we work on increasingly complex cases – and contrary to popular belief it is not just sore throats and backache – GPs are still criticised for shirking their social responsibility. As we strive to cover the gaps appearing in the NHS, it really is demoralising to feel that we are the scapegoat for anything that the NHS fails to deliver. The conveniently forgotten fact here is that responsibility for out-of-hours care no longer lies with GPs; it was handed in 2004 to the Primary Care Trusts (PCTs). Yet when the PCTs fail to cut the mustard, we still get the blame.

The situation couldn’t be clearer: if PCTs choose to cut cash and cut corners, then they will get a badly run, badly delivered out-of-hours service. If they fail to employ high quality doctors, then they will get bad care. If they fail to vet the companies that they contract to, then they can hardly expect to escape the blame for any unhappy consequences. Out-of-hours services need good management, good resources and high calibre staff. That is why the profession is getting involved. Here in Hertfordshire, and in many other areas, it is local GPs themselves who work out of hours, as the PCT has contracted with the local GP co-operative to provide cover. I can rest assured that my colleagues, working a co-ordinated shift system, are delivering a high quality of care. In other areas, often those where spending is lower, other providers have been used and there have been some terrible accidents.

If I, my partners and colleagues can deliver a high standard of in-hours general practice care throughout the country, why is it that some PCTs cannot deliver the same quality out of hours? Ask them. And stop pointing the finger at those who are keeping the NHS lights on.

Dr Michael Ingram is a full-time GP in Hertfordshire

Mark Briegal, Partner at comments on the article:

“This is an interesting article and one which will ring true for many of our GP clients.  Some of the comments it has elicited from readers are slightly scary and may make GPs wonder why they bother.  GPs can feel squeezed between the demands of their patents, the PCT contract, the acute hospitals and an aggressive media.  GPs are of course also running a business, with all that entails, on top of the demanding medical role.”

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