|
|
Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/web/20071014035036im_/http://bmj.com/icons/misc/sectionDOWN.gif)
Out of hours GPs are well qualified , good doctors
- Caroline A Mitchell (5 October 2007)
-
General practitioners still do provide out-of-hours care
- Robert L. Morley (5 October 2007)
-
Whos falt is this anyway and why make it any worse than it already is ?
- Alex G. Robertson (5 October 2007)
-
FINGS AINT WHAT THEY USED TO BE..
- Graeme Mackenzie (6 October 2007)
-
Should general practitioners resume 24 hour responsibility for their patients? Yes
- Imran Arfeen (6 October 2007)
-
TORONTO: After Hours medicine.
- Alexander FRANKLIN (7 October 2007)
-
No need for extended hours
- chris jenkins (7 October 2007)
-
Family Physicians
- Milind A Patil (8 October 2007)
-
OOH, General Practice and Sanity
- David P Jones (8 October 2007)
-
yes responsibility is for doctors to bear
- robert derek wintertton (8 October 2007)
-
In reply to Mr Wintertton above...
- David P Jones (9 October 2007)
-
in the long run - giving up out of hours has been a bad thing
- edmund willis (10 October 2007)
-
gp 24hr resposibility
- tariq m hama (10 October 2007)
-
The Good Old Days
- David Howard (10 October 2007)
-
Not keen!
- Rosemary B Martin (11 October 2007)
-
24 hours
- Gregory M Read (11 October 2007)
-
depends on format
- Duran Kandhai (11 October 2007)
-
24hour responsibility
- ravinder Norman (11 October 2007)
-
In support of the GP Co-op
- john m caine (12 October 2007)
-
GP Land
- Dr. Raja Baber Sheraz (13 October 2007)
-
Not either or...
- Steven Ford (13 October 2007)
|
|
|||
|
Caroline A Mitchell, GP/ Senior Lecturer Woodhouse Medical Centre, S13 7LY
Send response to journal:
|
This article initially implies that patients are only safe in the hands of experienced GPs but concludes with the suggestion that younger GPs could take a greater share of the ‘red eye’ shifts. Out of hours providers recruit fully qualified GPs to their rotas and all GP registrars have supervised out of hours training. This article unfairly implies that they are an inferior and under-qualified cohort. NHS complaints have increased- both in and out of hours. Commercial out of hours providers thrive but many providers were also established as true local GP co- operatives, where local GPs ‘opt in’ to shifts which most fit their working and home lives. All commercial and private out of hours providers have accountable clinical governance systems, where patient safety and good communication are paramount, and from personal experience, operate in a highly supportive and safe environment. Faced by an unsustainable increase in out of hours demand, and significant difficulties recruiting new partners, local GPs formed a city-wide co-operative which provided modern, safe premises, drivers & transport to bring patients to the primary care centre. Over 18 months there was a dramatic reduction in calls; to some (not the disabled and terminally ill), the attraction of an out of hours contact was a convenient but inappropriate home visit. The ability to opt into or out of shifts, in large efficient rotas, transformed my professional and personal life. In 1993 I was a single parent with a young baby. I would have lost my job had supportive partners not covered the 6 to 8.30 am for my 1:4 rota and without the support of friends who looked after my son until after at 11pm, evenings and weekends (an expensive deputising service covered 7 hours). Competing interests: None declared |
|||
|
|
|||
|
Robert L. Morley, General Practitioner Erdington Medical Centre 103 Wood End Road Erdington Birmingham West Midlands B24 BNT
Send response to journal:
|
Both Professor Jones and Dr. Herbert appear to make the same mistake in confusing the provision of out- of -hours GP care with the responsibility for organising it.When the profession voted to accept the new contract it did not make "the difficult decision to withdraw provision of out- of- hours", rather it chose to accept a contract which gave practices the option of whether or not to continue to organise as well as to provide twenty-four hour cover. Two facts need to be clearly understood.Firstly,many practices,particulary those with excellent GP co-operatives, chose to retain responsibility for twenty-four hour care.They continue to do this at financial cost to themselves because they recognise the value of this service compared to the PCO-commissioned alternative.Secondly,general practitioners still provide the out-of-hours medical care required for the patients of "opted-out" practices. GPs in these practices may have opted out of twenty-four hour responsibility;they clearly have not opted out of providing out-of-hours care and continue to provide it for the patients on their lists and those of other practices. Profesor Jones' article also implies that GPs in training and in the early years of practice gain no out-of-hours experience, and that they no longer do home visits.I am at a loss to explain this misconception. Competing interests: None declared |
|||
|
|
|||
|
Alex G. Robertson, GP principle western avenue medical centre, chester, ch1 5pa
Send response to journal:
|
Imposing a return to 24 hour responsibility will only exacerbate the predicted recruitment crisis. Those GP’s that are due to retire in the near future will see this as a reason to retire early ( as has happened with most major contract changes in the past). These people have seen to many changes in the last 30 years with out being subjected to this. The whole hearted welcome given to the opt out and its’ over whelming uptake surely points to the truth of this. The demands of out of hours care are no longer part of our duties and we should not be looking at taking them on again. However if we are forced to comply with this we should not make the same mistake as the government. We should ensure that we are appropriately remunerated for the task. We can not be held responsible for the idiocy displayed by this government in the past. It was obvious to all what was going to happen. I seem to recall that there were even questions on the Today program on radio 4 about this very issue. A survey carried out by the BBC at the time showed that the vast majority of us would opt out given the opportunity, something denied by the health minister as I recall. Now look at what has happened, as predicted we walked, and I for one can see no compelling reason to walk back. Out of hours is not our responsibility. It belongs to the PCT’s and ultimately the department of health. Where the system is failing they should sort it out. You wouldn’t take a second hand car back to its’ previous owner after 5 years hard use to complain that the tyres are bald. So why do we feel responsible for the current state of out of hours prevision in those areas where it is obviously failing. Competing interests: I am a GP and I also work in out of hours |
|||
|
|
|||
|
Graeme Mackenzie, OUT OF HOURS GP NORTH CUMBRIA
Send response to journal:
|
I am probably well qualified to comment on this issue having done 20 years as a GP principal and am now employed as a full time salaried GP in out of hours(OOH). My comments are as follows; Emergency OOH is an increasingly specialist role or should be. I was surprised how I had to skill up when I took by present job. Now that I am focussed on emegency primary care I realise that as a principal before co- operatives I wasn't doing that good a job. Rather that turn the clock back we need to move forward with specialists in primary care OOH. We possibly even need a separate defined speciality with recognised qualifications and bespoke/mandatory training. These doctors will in turn be able to extend their role and work much more with secondary care, not only to reduce admissions but to receive early discharges as well as defining best practice. Best practice is not necessarily reducing admissions, it is doing the best or the potential best for the patient. It is about avoiding, avoidable morbidity. There are many reasons why GP principals and daytime GPs cannot return wholesale to OOH. Geography is one, as many GPs no longer live in their practice areas. Many good co-operatives now have teams of OOH specialists. Replacing those with GPs who have not done signficant OOH for a while would be a risky business. Many co-operatives are now very professional with excellent call handling procedures, nurse practitioners, triage nurses and well developped links to district nursing and palliative care services. Is it suggested that we return to GPs sitting at home writing the calls down on the back of a cornflake packet? Does he suggest that instead of one point of contact, patients across an area take pot luck with whatever system practices have in place to handle their OOH commitment? Large co-operatives have well stocked emergency centres and vehicles with systems to maintain drugs and equipment. Many patients now benefit from immediate access to oxygen, pulse oximetry, IV lines, defibs, nebilisers, palliative care drugs and equipment and more. Large co-operative teams can back each other up if busy. Is it suggested that we return to the days of one GP struggling to cover a large practice with relatively limited amounts of equipment and drugs and absolutely no back up. Are GPs going to start visiting everyone as they did before? If not, you will need centres. Is every practice going to open all hours? If you centralise the treatment centres you are just recreating what we have now! OOH organisations and co-operatives provided a focus for complaints and comments on OOH care. Before them, there was nowhere for complaints to go because they would be against a practice or individual GP. Patients were less likely to complain in these circumstances and the complaints would not be recognised as relating to OOH care. The quality of care I provided as a GP principal working for a co- operative and now provide as a salaried GP is far superior to what I managed before when I had responsibility for regular on call. I resent the implication that OOH GPs are inferior in quality doing the more focused job of OOH. If you are just doing OOH, is the hypothesis not that you will be better. In the perfect world we would all want the doctor we knew seeing us at whatever time we wanted. That doctor would be fully conversant with all out medical history and when called would be polite and helpful to every patient he saw as well as very competent on OOH care. We all know that world never existed, that many GPs chronically resented the on call in a way which must have affected the quality of care, that with the amount of information on patients record nowadays it is safer to assume nothing: something the OOH GP automatically does. The future of OOH care may well be with highly trained, reflective OOH primary care specialists who are motivated to provide best and appropriate care under an umbrella of extended training and large supportive organisations. Competing interests: OUT OF HOURS SALARIED GP |
|||
|
|
|||
|
Imran Arfeen, VTS Trainee ST2 Scunthorpe General hospital, dn 15 7bh
Send response to journal:
|
I agree as a Gp registrar while working in OOH I realize the patient care is effected because of continuity of care, I am not sure about financial issues, My view is solely on Patient point of View. Competing interests: None declared |
|||
|
|
|||
|
Alexander FRANKLIN, Physician Private Practice
Send response to journal:
|
Dr.JONES mentions Canada. Am MBBS(Lond.1959);here since 1970.Can only speak for TORONTO where situation is mixed. The most personal service is given by GPs who charge up to $3,500 a year to register with their practice. They will usually answer a reserved telephone line at any time. GPs can also forward calls to a House Call service which arranges for a Home visit by a doctor in a particular area. The House call doctor bills the Ontario Health Insurance Plan(OHIP) directly, fee depends on time of visit-usually about $100, and pays a commission,(usually 30%),to the firm. GP groups will often take calls until 9 p.m. for which they are paid extra by OHIP. Afterwards a taped message usually advises patients to go to their nearest emergency department. There is also a Government-paid 24 hour Nurse telephone advisory service. By the way,Criminal Lawyers are available at any time; their fees about $500-700 an hour. From personal experience in UK & Toronto, House Calls are rarely Medically Necessary .Usually an excuse to save petrol and transportation costs plus the advantage of not having to wait in a GP's surgery during working hours. A convenience, just like home delivery by the baker,grocer and milkperson Competing interests: None declared |
|||
|
|
|||
|
chris jenkins, gp sw9 9tj
Send response to journal:
|
As a GP most of the patients that I see are either retired, have chronic illesses and cannot work, are under 5, or at school, are non- working refugees or asylum seekers, single parents, and working people off sick looking for certification. Most of these, especially the elderly do not want surgeries open after dark in the evening. Surely it would be easier and cheaper to let woking people see a second gp near where they work to sort out their mainly self imiting conditions. We already have a mechanism for doing that, its called 'Immediately Necessary Treatment', or for more detialed problems temporary registration for up to three months. What services are going to have to be sacrificed for paying for largely unnecessary extended hours Competing interests: I am a GP |
|||
|
|
|||
|
Milind A Patil, Medical Advisor, Pharma Company 410206
Send response to journal:
|
In fact, we in India, had this custom of calling GPs as family physicians. I remember my childhood days; the family physician was considered as not only a doctor but also a friend, philosopher and guide. He was not treated as a supplier of some services for a cost!! Unfortunatly, today this is not the case. Yes, GPs should take 24 hour responsibility for their patients. Competing interests: None declared |
|||
|
|
|||
|
David P Jones, GP - full time Bangor, Gwynedd
Send response to journal:
|
Like many of the previous responders, I worked in the "old system". We covered our own patients, 24/7/365. We did ridiculous numbers of unnecessary day time home visits, we rarely did any primary prevention and our surgery work essentially involved acute illness, diagnosis and referral of more serious conditions, the occasional terminal care, and repeat prescribing. House calls for minor problems were common and we soon realised that for every 1 call, approximately 7 patients could be seen in surgery. As time went by, we took on increasing amounts of primary prevention, so much so that by the time the 2004 contract was in place, I would imagine most practices, like ours, were up-to-scratch. At about the same time, in our part of the UK, a difficult semi-rural / rural area, a Co-operative was formed. Instead of 4 doctors being on-call covering 20,000 patients in one area, 3 covered a vast area covering 100,000 patients. And guess what? The expected warnings that things would be unmanageable did not materilise. The reason why this was so was because it was set up using data from other areas, we listened to others who had done it before us, and we learned. Now, 2004 contract. Why has this not been such a breeze? In my opinion, Government and advisers did not listen. They were told the likely problems. They were told GP's were already up to scratch with preventive care, they were told the budget for OOH was woefully inadequate (I personally informed the Welsh Assembly this in my discussions as the Chair of the local OOH in a meeting between us, NHS Direct, who triaged for us and the Assembly) - but all along they knew best and now they are looking for scapegoats. No GP is going to go back and work at the rate they were previously paid, and the introduction of market forces to primary care is a cross that this Government and their advisers are going to have to carry. My current work load, with all that it entails, does not allow time for OOH to be done. I would not be safe and I would therefore be doing my patients, and those of my colleagues, no service. It is time for the DOH advisers (whoever these faceless people may be) and the Government to wake up and smell what they have have landed the profession in, start to take advice from the ground workers (sorry professor but being in an academic unit and a surgeon does not qualify you to pontificate on my professional working life) who have been involved in the best Primary Care Service IN THE WORLD. And no, my hand did not slip and press caps lock by mistake - it was a shout! Competing interests: GP principal |
|||
|
|
|||
|
robert derek wintertton, paramedic medical centre nw6 3jr
Send response to journal:
|
yes doctors should bear responsibility for their patients 24 hrs. there are holidays and other entitlements to enjoy. part time apart from health and family reasons should not be out of right. patients suffer form the current system with increase of hospital referals and improper control of hypertension, diabetes, anticoagulant therapy. patients require help and if you are not dedicated enough do not come to medicine. it is not shop keeping. sincerely WINTERTTON(MR) Competing interests: None declared |
|||
|
|
|||
|
David P Jones, GP - full time Bangor, Gwynedd
Send response to journal:
|
Part time - I wish. I work full time - 5 days a week - mostly 11-12 hour days with a "working lunch" and afternoon coffee, if I am lucky, whilst I scramble through mountains of paperwork. I take 6 weeks holiday a year, as my partners do, which means when they are away (which effectively is half a year) their work needs covering. I would like to know what other entitlements you allude to as it is clear to me you have no idea of the primary care set up. You, as a paramedic, will work a shift system. You will have time off to compensate and your hours are governed by the European Working Time initiative, unlike mine that do not come under this legislation. Individual GP's cannot cover their patients 24 hours a day and remain in safe control and you would not want me to be taking critical decisions for your patients (or indeed your family should they be unfortunate enough to need care) at 3am when I have been working without a break for 20 hours. Think about it that way then think again ................ Competing interests: Full time working GP |
|||
|
|
|||
|
edmund willis, gp bridge street surgery, brigg, north lincs, dn20 8nt
Send response to journal:
|
GP's are perceived as overpaid and lazy, and we are being punished by the government for it. If we had kept control of out of hours - we would have a much better standing as a profession, and have a lot more support from the public. The government would have been much less likely to use us a general whipping boy. My regular patients are amazed when they see me working for one of the remaining outof hours coops. They beleive the media which tells them that gp's dont do out of hours. The perception that we all were doing out of hours before and now none are is particularly absurd as very few GP's were formerly unable to use deputising services. The double whammy we are in now is that PCT's now realise how much it costs to organise an effective service and are providing a token service - for example 1 doctor on at night for the city of hull and a huge surrounding area! The resulting service is terrible for patients.. and who gets the blame?? why us of course who provided a mostly good service cheaply for years. We need to offer to take this job back - there are now lots of doctors who are prepared to work out of hours. If we did this we would improve our reputation, and that would work to our advantage in the long run. We would also resist the the tide of Emergency care practitioners, nurse prescribers, specialist nurses, counsellors, who threaten to take over 'Primary Care'. Competing interests: i am a gp who does out of hours work |
|||
|
|
|||
|
tariq m hama, gp principal kimberley ng16 2nb
Send response to journal:
|
gps too have families which require valuable protected time why should they be denied this Competing interests: None declared |
|||
|
|
|||
|
David Howard, GP and Trainer Stonehaven, AB39 2TR
Send response to journal:
|
Why would anybody want to go back? We can still work out of hours if we want to for raesonable remuneration. Those who prefer a good night`s sleep can go to work refreshed. Recruitment has improved. What were the chances of seeing your own patient previously out of hours unless you worked very onerous rotas? Those who advocate a return to the good old days are aiding our masters in an effort to cut the cost of OOH care pure and simple. Competing interests: None declared |
|||
|
|
|||
|
Rosemary B Martin, GP principal M14 6 XU
Send response to journal:
|
The day job has undoubtedly got harder under the new contract. The patients who consult by day have every bit as much right to a good service and the two jobs cannot safely be done by the same person. Competing interests: None declared |
|||
|
|
|||
|
Gregory M Read, GP Fressingfeld Medical Centre IP21 5PJ
Send response to journal:
|
I would love to go back to the good old days of 24hr responsibility (it was actually one of the reasons I chose general practice as a career), if there was the necessary support for carrying it out, in both financial terms and in generating an attitude from the patients that it was not an extension of our daytime work - an attitude persistently encouraged by the present Government with its obsession with access. Unfortunately, neither of these pre-requisites will happen. The Government has blatantly encouraged patients to expect a service at weekends and out of hours that is unacceptable to most hardworking general practitioners - this attitude is based on the Tesco's model of "get what you want when you want it" even if it is 3 o'clock in the morning. The difference is that Tesco's know that they can afford to do it making a fabulous profit to boot and also employ their staff on a shift- based system. The person on the cash till at 3 o'clock in the early hours won't be there holding the fort at 9 o'clock later the same morning! The deliveries arrive and the shelves are stocked to accomplish a seamless shopping experience even though it is at a time when most people are asleep. I doubt whether hospitals and other areas of the NHS will be able to provide an equivalent routine service during these times to make our efforts worthwhile when we are providing the required routine OOH service that will be expected of us. If one looks at the way most PCT's organise their finances in order to pay off the massive debts that were there when they came into being, they exert a huge downward pressure on practices to do everything as cheaply as possible or stop commissioning certain services because they are too expensive. How on earth are they going to afford a 24hr service manned by doctors when they are finding it so difficult to provide one on the cheap at present with nurse practitioners and paramedics and bases spread so thin that our patients sometimes have to travel 50 miles to see a doctor or other healthcare practitioner. I worked out that when I did my OOH work and Saturday mornings for the first 10 years in practice, I earned about a pound an hour! I also missed my young daughter growing up in her early years because of the times that I wasn't there. This is something that I would not accept again, especially as I am much older and I wouldn't expect my younger colleagues to be put in the same position. Even when we set up an innovative General Practice Co-operative in our area, it was apparent, as time went by, that the service was starting to be abused by an increasing number of unnecessary calls and the added stress that came with them. And of course to provide this service we had to pay back our membership by working the requisite number of shifts. Professor Jones, I'm afraid, is typical of the type of GP, who, despite of his excellent skills as a GP, has found other things to do in the world of academia - and this is not denigrating that what he does isn't important for British General Practice. If I am wrong then I apologise, but I doubt whether he spends every week of his working life from 8-6.30, on the coalface, seeing patients and, thus, in his own way, he has already opted out. I hope that I am not a dinosaur and that there maybe many GPs who feel the same as me. If it comes to the crunch then I will consider my options and retire early, even though it will affect my financial future. I don't think anyone would disagree with the fact that a doctor based OOH system and thus, a return to 24hr responsibility would be the gold standard for general practice OOH but, it requires a sea change in attitude, particularly from this and future Governments - they cannot rely on doctors goodwill to work unsociable hours for no additional income because it's perceived to be a duty that comes with the job. I think that this was why so many of us decided that enough was enough in 2004 and opted out. The only way that a return to 24hr responsibility will work, is if the number of GPs working in the NHS increases dramatically in order to allow a practice-based shift system to work effectively and safely, as well as there being a secure and protected financial package for those who carry it out. Competing interests: None declared |
|||
|
|
|||
|
Duran Kandhai, GP-Principal Newport, NP19 8XR
Send response to journal:
|
GPs are independent contractors and I feel that any action even by stealth to impose working unsociable hours(out of hours; 24/7 care) is certainly not acceptable and should forcefully with full support by all stakeholders be rejected. Nonetheless I agree that many GPs would be willing to work OOH(Out Of Hours; 24/7 care)and indeed should have the opportunity to do so in a suitably priced contract, i.e. that reflects the risks, time investment and sacrifice of family/social life. Furthermore some arrangement should be possible whereby the GP who worked the evening or night before should have at least the next morning off. This would be the only way forward to achieve 24/7 care that is acceptable to both patients and doctors. Let's not forget that patients nowadays regard a tired and overworked doctor as "non acceptable" or "risky". Competing interests: I'm a GP Principal |
|||
|
|
|||
|
ravinder Norman, GP YATELEY GU46 7LS
Send response to journal:
|
NO to OOH-our daily practice demonstrates that the more availability we have the greater uptake .NHS Direct A&E; walk in clinics do not necessarily prove that there is a need.[A vacuum is filled]Other than true emergencies -of which there are few-most of health care needs can be dealt with during normal working hours. A trial of GP's in A&E; only demonstrates how perceived needs by the public and desire to be seen when, where etc, fuelled by the Governments desire to give everyone what they want rather than sensible use of services -this is not rationing-creates a need where there wasn't any. The best way as was just beginning to be shown by fund holding then by local GP co-ops is that given funding and support and the trust by MPs .GP's can deliver very good, comprehensive services. Competing interests: None declared |
|||
|
|
|||
|
john m caine, GP parbold, lancs, wn8 7nb
Send response to journal:
|
Prof. Roger's arguments for the return of 24 hr 7/7 responsibility seem to be that it would improve GP training, reduce admissions and improve patient use of the service and their safety. Oh and that patients would like it and it might be cost effective. His evidence for these assertions is what exactly?. He states that Heath's (1) opinion was that 'OOH was becoming a shambles' -yet her article is actually calling for an end of the cheaper skill-mixing attempts of some OOH services to introduce non-GP first contact clinicians into OOH and promots the GP Co-ops who have managed to stay in business by opting -in. He claims that Wanless (2) blamed the steep rise in A&E; attendances to changes in OOH arrangements - but Wanless actually blames the A&E; obsession with 4 hr waiting times along with the OOH changes and gives no evidence for either - In fact the steepest year on year rise in new contacts occurred between 2002/3 and 2003/4 (15% increase) before the new contract came into effect c/w 9% between 2003/4 and 2004/5, and 6% and 2% in the last 2 years. He claims that OOH is provided by 'less experienced clinicians'. Where is his evidence for this assumption?. Does he have a breakdown of the OOH workforce, that no one else has, or is he still peddling the media prejudice? My prejudice is that the vast majority of complaints in the MPS report he quoted will be in those organisations whose main aim is to provide a service based on cost rather than quality, i.e. the private companies and the in- house PCT run organisations- by the way how does the rise in OOH complaints compare with the number of complaints about the NHS in general? Is there a general increase in complaints across the NHS or just in those who are getting the worst press? It is difficult to see what points he is trying to make from his international comparisons. Australia have a private health care system where GPs get paid for each contact and where GPs can reckon on only a third of their registered patients seeing them regularly -the others popping into whichever GP takes their fancy. Roger espouses their stringent guidelines for communication but doesn't elaborate on these. My personal experience of working OOH and in hours in Australia is that continuity of care is a shambles. The OOH quality standards in this country (3) insist on all OOH contact records being faxed/ emailed to the patient's GP by 8am the next morning- If only information regarding our patients’ attendance at A&E; or Walk-in centres came as quickly ( I’ll leave to one side the scandalous time it takes to get outpatient letters or discharge summaries) In Canada they apparently have a system of extended rotas, which he claims is what Heath also calls for. This sounds fine to me but we haven’t we been there already? Oh yes I remember they are called GP co-ops! Where these have been allowed to carry on- either by opting in and doing their own thing a la Heath, or by opting out yet being unmolested by PCTs- they continue to provide a high quality service, staffed by local experienced GPs, with excellent lines of communication, and support for younger doctors and training for registrars- does that tick all your boxes? 1.Heath I. Out of hour’s primary care—a shambles? BMJ 2007; 334:341. 2.Wanless D, Appleby J, Morrison A, Patel D. Our future health secured? A review of NHS funding and performance. London: King's Fund, 2007. 3. national quality requirements in the delivery of Out of Hours services: 2006 Competing interests: full time GP and OOH Director |
|||
|
|
|||
|
Dr. Raja Baber Sheraz, GP ST2 Staff hostel, West cumberland hospital, Whitehaven, CA28 8JG.
Send response to journal:
|
Gp treats the whole patient, not "chest pain", "ankle fracture" or "another neck of femur". Thats what we call as "Holistic approach" in our GP land. Even if the GP works from 0800 to 1700 it does not mean that he/she is not owning the patient. GP gets the feedback from the patient very next day that is not the case in minimum three monthly hospital consultation. At the moment the balance is right between the primary & secondary care. Yes i do support the transition of some specialist work into community, closer to patients own home provided by their own doctor. GPWSI Cardiology is an example! To maintain & improve the quality of general practice we need to give our GP`s a suitable work life balance by giving them the choices of opting in or out of out of hours work. General practice has become a emerging popular choice among our post foundation programme doctors. Bringing out of hour work into primary care "24 hours responsibility" may affect the future career choices! In the current setting General practitioners are doing a great job in providing excellent healthcare to the local community. Suggestion: Why not make small primary care zones & GP`s can do out of hour work in their own practice zones. The benefit would be that patient requiring home visit won`t see a new face! I am sure with this healthy debate we might find an acceptable solution to all which continues to provide the best primary care to our local communities. The important bit would be to include hospital Consultants, GP`s, Current out of hour providers, media & most importantly our own patients! Competing interests: None declared |
|||
|
|
|||
|
Steven Ford, GP Haydon & Allen Valleys Medical Practice
Send response to journal:
|
Editor There need be no contest here, merely the flexibility to adopt the approach that best suits the patients, doctors and geography. My own practice did its own OOH until confronted by 'force majeur' and I only stopped doing OOH altogether when it degenerated into a call centre operation. A diversity of provision arrangements is the right approach. Yours sincerely Steve Ford Competing interests: I am a GP |
|||