Most GPs were relieved to get rid of the responsibility for 24-hour care, but there are still some patients who need the Jobbing Doctor’s mobile number
When I first started in general practice, the practice had a ‘list’; that is the patients who were registered with each individual doctor. Although the tendency was for doctors to work in groups, each patient actually had a named GP.
You were responsible for that patient 365 days of the year. You would decide how this could be managed – for example with holidays, for example – but it was essential that your patients were covered all the time.
I decided, as a young doctor, to turn down a partnership in a two-doctor practice, as I felt that the on-call, whilst not that busy, would still have been oppressive (there would be periods in the year when I was on-call for every day and every night if my partner was away).
As general practice got busier and more involved (more and more routine hospital work was being done in general practice), the days became fuller, and it was clear that we needed systems to cope with this. The group practice of five or six doctors flourished, so that internal cover was an option, and for others the use of a commercial deputising service was an option. The on-call then diminished to about one day a week. The junior partners tended to be on call on Mondays and Fridays (last in, worst days).
This is pretty much how my work was till around the mid-1990s. We always did out own on-call because we looked after our patients in the local GP maternity unit, and were even on call on Christmas Day and other high days and holidays, as babies didn’t look at calendars.
The 1990s was the decade when Government started to interfere with primary care in a big way. They commissioned a report from a loyal supporter to look at maternity services, and within two years of that report, we had the virtual disappearance of GP maternity care, despite the facts that GP maternity care was safe, popular and inexpensive (I should know, because I wrote my Masters’ dissertation on this subject).
There was no reason, in my practice, to be on-call on holidays, and so we paid for a commercial deputising service to do it. This was the start of the end of 24-hour care.
Does it matter? In some senses it doesn’t, as we were getting to the point of not being able to cope with increasing demand, and a tired doctor is a dangerous doctor. But we have lost a great deal because of this. Patients get admitted at night and at weekends when they don’t need to. Accident and Emergency departments have become like military field hospitals, and that is because much that goes there is neither an accident, nor an emergency.
It matters most in palliative care, however, as this is one area that I steadfastly refuse to hand over to anyone else. I remain on-call for my patients who are dying at home all the time. Clearly, I won’t be able to look after them if I am out of the country, but at other times I will.
I do this by two simple methods – the family (and patient) have my mobile phone number, and they know that they can call me at any time. Interestingly, it is very rare that anyone abuses this.
The other thing that I always do when I am going away is that I ask the family which doctor they would like to deal with any problems whilst I am away. Then I speak at length to that colleague.
Thus continuity continues.
The Jobbing Doctor is a general practitioner in a deprived urban area of England.