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Sticking salaried GPs on sundowner shifts puts us on road to polyclinics

Things are hotting up and extended hours are coming. But who will do the sundowner shifts? Well no prizes for guessing. Someone whose job title includes the words 'salaried' or 'locum'.

The RCGP says the doctor-patient relationship and continuity of care are at the heart of the consultation. Its road map clearly states in section 3.9 that 'being a doctor involves adoption of a moral principle that commands the doctor to place the needs of patients before his or her convenience or interests'.

So the high command makes it clear that doctors should focus on patients' interests - but what are these?

An online poll by The Times on 23 February found that 49% of patients would prefer to see the same doctor for each consultation, and 61% wanted to see their GP in the evenings or on Saturday mornings. Only a minority (26%) were happy to see any doctor on every consultation. It seems many patients want to be able to see their own personal GP during evenings or weekends.

Of course, partners can't be available 24/7, but my concern is that although the RCGP opposes 'Martini' polyclinics (any time, any place, any doctor), the only Martinis around may be shaken on the garden patio of a partner while their army of subcontracted subordinates beavers away on the sundowner shifts.

Patients and doctors agree that the special relationship between a patient and the GP who knows them best must be protected.

This is a major moral basis of the objection to polyclinics. Yet if GP partners merely subcontract out their evening shifts, practices will themselves be on the road to becoming polyclinics.

Time will tell who will be absent on the sundowner shifts. Will it be you?

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It appears to me that Lord Darzi is doing to NHS general practice what Dr Beeching did to the railways. History is repeating itself and, once again, no one who realises it appears to be a position to prevent it.

From Dr M H Seville, Morecambe, Lancashire

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