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GP registrars don't need training for out-of-hours

The position paper by the Committee of General Practice Education Directors on out-of-hours training (News, February 23) sadly reflects the failure

of a large number of our influential leaders to grasp the unavoidable reality of the change occurring in general practice today.

From an honest appraisal of my own 33 years in practice I long ago concluded that out-of-hours practice is not one jot different to in-hours practice. A patient with an infection, surgical emergency, depression or any other condition is just the same whether in the morning, noon or

early hours.

In the past the only difference was that the GP attending out-of-hours would be tired from working all day, undervalued, underpaid for the service, grumpy for being awakened and more likely to make a wrong decision.

This is why most GPs have fought so hard to ditch out-of-hours work and to reform it as a separate, well-paid type of shift work.

We just don't feel safe providing a tired-out 24-hour service dealing with patients whose only real excuse was often that they just couldn't be bothered to book a normal appointment.

There are no special differences involved in visiting or consulting with patients during the day or going out with a trained minder and driver at night.

Registrars should take it from one who knows. There is, quite honestly, no mysterious X night factor to learn. Just as none of us ever had special training to be woken up in the night to see an acutely ill patient during our hospital jobs so the extra training needed for being a GP at night can be picked up easily in a single night by any intelligent medical graduate with four years' postgraduate experience.

My advice to the educational directors is: stop making educational mountains from molehills. Concentrate on developing new training for the future of general practice ­ not the past.

Dr John Clayden


West Yorkshire

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