Last weekend I did a couple of GP out of hours shifts in Dundee. I confess even at my career stage (and what I do as BMA Chair of GPs in Scotland), I was a bit anxious before I started as I’d not done any OoH work for 2 years, however once I was logged into the IT (I always fret about the passwords) it was really very straightforward and I would say quite a good experience.
While it was fairly steady work over each 6 hour shift, with just one 15 minute break in each for a quick sandwich, I felt well supported by the Tayside OoH team and was in control and never under excessive pressure with what was averaging 4 patients an hour. The first shift I was sent out in Car 4 with my driver Colin.
When I think back to what OoH was like before 2004 then what a luxury it feels to have a driver, just sit back, have a read of the patient notes, watch the world go by and let someone else worry about finding the right house, and with the safety knowledge that when you are on the call there is someone outside waiting on you. You can also have a good chat in between calls with your driver and so the time soon passes. The visits were generally to older and frailer patients, those genuinely housebound with many living in care homes.
Second shift I was based at the Dundee Kings Cross centre and there was a steady stream of cases, but you work at your own pace alongside other GPs and nurse practitioners all picking from a pool of patients who have been triaged by NHS24 and given an appointment time slot, ‘walk-ins’ are strongly discouraged. The cases were all appropriate, a mixture of children, coughs, urinary symptoms with the occasional rash, chest pain or alcohol withdrawal. Compared to daytime general practice it was so much more straightforward, there were no shopping lists, no ‘while I’m here doctor can I just mention the dizziness I’ve had for last 3 years’, and no paperwork!
So would I do it again? Absolutely I would, out of hours is part of general practice, we as GPs need to support it and not give it over to hospital care. But the pre-2004 model had to change, being on call on your own for 15 hours, driving yourself through the night on home visits should be a thing of the past ( I do acknowledge that in our most remote areas of Scotland there are some GPs who continue to do this – I know because I’ve recently been there – you do a great job).
The public demand and need has changed, it requires greater investment and it is right we should be working more as part of a primary care team with nurses, pharmacists backed up by call handlers and drivers. It is appropriate that the service is run by the health boards, the OoH services deserve more credit for what they do, at nights, festive periods and weekends it’s not just about A&E, NHS Scotland and the media should give greater recognition to a service that provides almost a million patient consultations a year in Scotland.
Of course, it is important to recognise that my recent experience of OoHs work may not be typical – indeed some of the anecdotal evidence we have of services under serious pressure suggests it may be somewhat untypical. I know from colleagues – for example in Glasgow – that their OoHs system is stretched to the very limit.
I believe the root cause of this is simply the fact that there are not enough GPs working in Scotland – and those who are, face such demanding workloads that adding out of hours is just a step too far. So we need more GPs, and as a result that will hopefully mean more GPs in a position and able to do OoHs. I hope the new contract, when it is implemented fully will make an impact on this.
Finally as a matter of great urgency the UK Treasury must sort out the pensions tax issue that is threatening to totally destabilise these services which depend on a relatively small number of clinicians who in many cases are doing essentially overtime from their day job. They are not going to continue to work OoH if they risk facing ludicrous pension tax charges that mean they are better off staying at home.
The same crazy rules are affecting our hospital consultants willingness to do waiting list overtime, so please Mr Chancellor and Mr Health Secretary you had better fix the annual allowance rules properly and now or else risk spiralling waiting times and a genuine crisis in OoH care – which in some places is already facing huge challenges.
Andrew Buist, Chair of the Scottish GP Committee
If you’re not a member of the BMA and feel inspired to join and make our collective voice stronger, please click here. If you’re already a member and want more information on how to make the most of your membership, please click here.
bmascotland.home.blog 