Friday, 31 May 2013

6 reasons why out of hours is out of control

There's a lot in the press currently about GPs and out of ours cover. The claim is made that the loss of  out of hours responsibility since 1996, is chiefly to blame for our A+E departments being overwhelmed. I very much doubt it. However something has changed in the demand for out of hours medical attention.

For the first half of my GP career I was on a rota with the rest of my partners and a neighbouring practice, for out of hours cover. This roughly broke down to one night during the week and one weekend in five. Calls at night were infrequent and I guess I had to get out of bed and visit roughly 30% of the time. Just about always the visit was appropriate. But in the early days of GP co-ops and the night shifts which I did, it became quickly apparent that demand for medical advice at night was sought much more readily, and for ever minor problems. Why the increase? Here's some suggested contributing factors:-

1. The resident older population  had grown up with the development of the NHS. Calling the doctor was a big deal. For my parents generation born in the 1920s, make do and mend, didn't just apply to sewing.
2. Not only did respect and deference prevent calls to the doctor for minor problems, but there was a greater resilience  (which likely also contributed the semi-mythical, 'blitz spirit').
3. As a child, I still recall having to cycle a few hundred yards to the public phone box to call the doctor for my mother. The eponymous mobile phone makes it all too easy to ring 111.
4. The influx of many from different cultures has had a massive effect upon out of hours demand. There are language problems, a different attitude towards A+E (in many Europen countries it is expected that you will just rack up at A+E with any medical problem), and often a lack of resilience, partly resulting from very tough social circumstances and perhaps poor parental mentoring.
5. Some of us GPs are perhaps to blame, for not establishing good relationships with patients, and not taking the time and trouble to educate them about managing symptoms overnight. However I realise that colleagues with ethnically diverse lists have massive challenges to communicate  well when language and cultural expressions of symptoms make good GP nigh on impossible.
6. The 24 hour culture of shopping, whether it be online or the ubiquitous Tesco, has had a significant, and I would say unhelpful  effect upon expectations. I can understand why one might want to buy petrol in the night, but do I really need to buy groceries at 3am?
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