As the number of complaints regarding out of hours services are rising in the United Kingdom, two experts debate whether General Practitioners (GPs) should resume 24 hour responsibility for their patients. You can read the Head-to-Head article in the British Medical Journal (BMJ), this week’s issue.

Yes – Roger Jones, Professor of General Practice at King’s College London

Roger Jones explains that the new GP contract, which was introduced in 2004, allowed GPs to opt out of 24-hour responsibility. The result has been that the best trained GPs work mainly during the daytime, while the less experienced ones work at night. He suggests that a patient who becomes ill at night has a higher chance of being treated by less experienced doctors.

R. Jones argues that this situation leads to fragmentation of care, higher risk of communication errors, and probably dearer running and unnecessary inpatient costs.

“I am not suggesting that all general practitioners resume out of hours responsibility for their entire professional life. And I am certainly not supporting the view that surgeries should be open at all hours for routine care – this entirely misses the point,” he explains. “However, during vocational training and in the early years of practice, seeing patients in their homes, assessing acute medical problems, and making appropriate decisions about treatment and hospital referral should be regarded as core aspects of training and professional development, just as they are in hospital medicine.”

Jones is convinced that for most patients and doctors, a return to a more personal 24-hour approach would be more beneficial. He explains that he has, himself, worked out of hours and understands the difficulties of re-engaging with personal out-of-hours care.

No – Helen Herbert, Chair of the Royal College of General Practitioners in Wales

By giving up out-of-hours care, many have accused GPs of no longer being interested in what happens to their patients. However, Helen Herbert stresses that the change was made precisely because GPs want the best care for their patients.

She remembers covering out-of-hours care and frequently being exhausted. Health care professionals should not be making life-threatening decisions if they are sleep deprived, Herbert argues.

As primary care organizations are responsible for providing out-of-hours services, Herbert explains that it is unfair to complain to GPs about it. General Practitioners are the solution to improving urgent care services. Herbert acknowledges that there is some confusion and fragmentation in out-of-hours services. However, she also points out that when it is properly organized and resourced out-of-hours care works well, and with a high level of patient satisfaction.

The difficult decision to withdraw responsibility for out-of-hours care was made precisely to guarantee the safety of patients, as well as the recruitment of future doctors. It is imperative that responsibility for these values is preserve, that excellence in preventative care is optimized by influencing the providers, commissioners and policy makers.

“Head to Head: Should general practitioners resume 24 hour responsibility for their patients?”
BMJ Volume 335, pp 696-7
http://www.bjm.com

Written by: Christian Nordqvist