Be prepared to compromise and review contingency plans
This dilemma asks difficult questions about competing priorities – your practice and your personal life – and is never easy. If you already have difficulties providing patients access to GPs, you might feel obliged to cover the surgery. However, your personal life is important too.
Most patients are quite understanding so would accept some changes in this circumstance, such as being offered another appointment with the same or different doctor. However there might be some who have already made special arrangements and might be less flexible. Sending people to an out-of-hours service or A&E might offer false economy as patients will request another appointment if they felt their needs were not adequately met.
You might wish to compromise by asking your receptionist to rearrange as many appointments as possible but to make you available for part of the surgery, say an hour or two, to see those who are unable to rebook. You might be late for the birthday party but this might be the ‘least worst’ outcome.
On a reflective note, you might wish to review contingency plans for days when there is reduced capacity – e.g. Saturday – and whether this service is feasible in the long run. You might also wish to consider if a clause should be included in your partnership agreement to provide clarity in this type of scenario.
Lastly, recognise you might feel angry or annoyed but manage it appropriately, not by showing it to your patients, staff or the sick partner. You have a birthday party to look forward to.
Dr Richard Ma is a GP in Islington, North London
Partnership should be based on mutual responsibility
If an individual feels unable to make this call, I would endeavour to suggest that partnership is not for them. There are, after all, other, salaried, roles in general practice, which I would suggest, do not bear this degree of responsibility.
This decision would depend upon all partners in the practice having the same definition of what ‘partnership responsibility’ meant, and acting accordingly.
My decision would also be based upon the frequency of such ‘last minute illnesses’. I should also need to know that ‘stepping in’ would be reciprocated if I were similarly incapacitated.
It is my belief that if one partner in a practice does not feel similarly committed (or abuses the ‘goodwill’ of others to step-in), this would represent a serious breach of trust, and thus grounds to review the whole partnership.
As a mother-of-three, including twins, I also appreciate that in order to make the decision to step-in, one is reliant on a robust family support system and a flexible workforce of friends, that can ‘cover’ one’s absence from one’s own child’s party, with a smile on their faces, for at least a couple of hours.
Dr Vicky Blackburn is a GP partner in Gloucestershire and has a regular phone-in on BBC Radio Gloucestershire. She is also a member of a private GP service based at a local private hospital and regularly participates in the local out-of-hours service
Triage the patients booked in to establish urgency
In my opinion, the patients should come first and I would advise against cancelling the surgery or directing patients to an A&E department – but don´t cancel the party.
One solution might be to triage the patients who are booked in order to establish which appointments are urgent and which are not. In general, Saturday morning surgeries are fairly quiet. The surgery could also bring in a nurse, a nurse practitioner or prescribing nurse to carry out consultations over the phone.
It is important not to cancel surgeries and turn patients away – this could lead to patient dissatisfaction and complaints, as well as extra pressure on NHS colleagues working in the local A&E department.
Could you get temporary cover from family and friends for the party until you are able to leave the practice? Could the party be postponed for an hour or so?
If situations similar to this arise in the future, the practice will need a policy for when partners are unexpectedly sick or require cover. This, along with other contingency plans, could also be laid out in the partnership agreement.
Ruth Long is general manager at First Practice Management