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At the heart of general practice since 1960

Brown's clever - but I hate him for it

Phil's practice won't be doing extended hours - and he reckons you'll regret it if you do

Phil's practice won't be doing extended hours - and he reckons you'll regret it if you do

Thousands of practices across the land are starting to open their doors to provide extended access to their patients. My practice isn't one of them.

It's a bit pointless, at this stage, to reiterate the many ethical, practical, and economic reasons why it's a rubbish idea – but maybe it is a good time to examine one aspect of extended hours that I do not think has had enough exposure within the profession. I am referring to the problem of the ‘walk-ins'.

Back in the old days, when we were responsible for out-of-hours care, we opened on Saturday mornings. We had no booked appointments, and would see anyone who thought they had a medical problem.

We have about 8,000 patients, and on any given Saturday about a dozen would turn up with problems they thought needed urgent attention. We wouldn't always agree with their assessment, but we would see them anyway.

As a result of our shameful Government's craven and dishonest manipulation, many practices feel they have to open on Saturday mornings and some evenings again, but these new surgeries are apparently specifically designed to consist of only pre-booked routine appointments for the benefit of those mythical punters who are unable to see their GP at any other time.

There is no mention of those ‘urgent extras' who are inevitably going to darken the doors.

People feel ill and children get pyrexial on every day of the week, and if your surgery is open, they are going to turn up. Never mind if you have put it about that you are only going to see people with appointments – they are going to rock in, unannounced, to see you. And what are you going to do? Turn them away?

I am on the LMC in Sunderland, and we have discussed this. We think it is perfectly reasonable to redirect people to the out-of-hours services if they don't have an urgent medical problem, but we also accept that we have to put ourselves in a position to sensibly and rationally assess that.

Not life-threatening

What does this mean, in practical terms? The punter is already in the waiting room. Do we see them, conclude that their sore throat is not life-threatening, and tell them to go to see a nurse in a walk-in centre three miles away?

How might our patient react, when the prescription pad is lying there on the desk? And how might they fill in their patient access satisfaction survey when it falls through their letterbox?

Alternatively, we could rely on our receptionists to assess whether the patient seems significantly ill. They are, on the whole pretty good, at this. But they're not perfect and eventually when (and, I stress, not if) they get it wrong and the patient suffers as a result, we will not have a leg to stand on.

So there we go. I suggest it is not ethical or practical to refuse to see walk-in patients, and I predict that every practice that opens on Saturday mornings will end up seeing twice as many patients as they plan to. Our Government is morally bankrupt but far from stupid, and I am sure they already know this.

Reluctantly, I am impressed. You will be forced to conduct many consultations for no recompense, and a significant amount of pressure will be taken off the OOH services at no cost to Gordon Brown.

It's clever, I'll grant you. But I detest him for it.

That man has promised the electorate they can see their own GP whenever they want to. He has backed up his promise with our time and our money.

Dr Phil Peverley is a GP in Sunderland

Significant pressure will be taken off the out-of-hours services at no cost to Gordon Brown'

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