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At the heart of general practice since 1960

OOH doctors' duty is to patients, not the clock

I read the article on out-of-hours medicine with great concern.

Although there is a need for performance management of some sort by out-of-hours providers, what was being described in the article appeared crude and potentially inaccurate and unfair.

If your article is right then a doctor's first duty now is not care of the patient, but the saving of time, money and admissions.

These are not the conditions in which good medicine can be practised.

The demands being made by PCTs are creating risks for patients, and increasing further the stress felt by doctors.

As doctors we need to be very assertive in stating our right to practise medicine without hindrance, and to make the best decisions we can at the time, for and with our patients.

If the NHS cannot afford for us to do this then the problem is the NHS, not the doctors. And if the NHS prefers to pay out for consequent negligence rather than for enough staff and facilities in the first place, then it is an even sicker organisation than I thought.

Dr Peter Davies, Halifax, West Yorkshire

We've been doing extended hours in my part of the world since 1981, but it has generally gone under another name, such as the 'doctors' out-of-hours emergency service'.

While generations of MPs have been sleeping in their beds, dreaming of their expenses, doctors have been seeing 'routine cases', on demand, at all hours of the day and night for daytime problems.

I do not think the powers that be have properly appreciated this rampant misuse of the out-of-hours service.

I can also predict with confidence that demand for the new extended access slots will rise exponentially, but will be surprised if this eases strain on out-of-hours or hospital A&E services.

The introduction of walk-in centres some years ago actually raised demand on the local out-of-hours service, rather than reducing it.

Dr T E Kenny, St Helens, Merseyside

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