Exclusive: What GPs say about taking back out-of-hours duty

More than 1,000 GPs responded within 24 hours to a GP magazine poll asking whether the profession should take back out-of-hours responsibility. Below is a selection from almost 300 comments left by GPs setting out views for and against the move.

Out-of-hours care: GPs reject call to take back 24-hour duty
Out-of-hours care: GPs reject call to take back 24-hour duty

Nine years on from the 2004 contract that allowed GPs to opt out of out-of-hours responsibility for patients, our poll found that around 80% are opposed to taking it back.

Many of those opposed to taking back 24-hour duties cited workload concerns and warned they could retire early if forced to cover out-of-hours.

But many GPs believe they could improve significantly on existing services given proper funding.

Against:

I would definitely retire if this is imposed - I worked on call at nights and weekends for 25 years, often up all night and hated every minute of it. My father was a single-handed GP and never off call - he didn’t live long after retirement - the workload in the day is now so labour intensive that doing night and weekend work will be impossible.’

The best thing that ever happened to general practice in my career was the option to opt out of OOH provision for a reduction in our income. The government underestimated the value of the service we offered and offered contracts to the lowest bidder, with predictable results. OOH cover could be improved without us taking responsibility if it was adequately funded. This is Jeremy Hunt's responsibility not ours.’

Even as a salaried doctor I already work 12-hour days in the surgery, which includes between 7 and 8 hours direct patient contact time other than home visits. I would be unsafe to work additional on call in a day on top of this, and am unable to work at evenings/weekends due to family/childcare limitations.’

Never. I only voted for the 2004 contract to definitely get rid of the 24-hour responsibility. With all the modern governance issues to run out-of-hours they only want that so we do it when no one else will. I don't leave the surgery til about 9pm after 13 hours at work, ie only two surgeries. I couldn't get to OOH to do an evening session and I cannot/will not work over night ever again.’

DEFINITELY NOT! I'd resign & work abroad if that happened. We don't expect consultants to have 24/7 care for their patients so why should GPs be held to a different standard. It's not GPs’ fault the previous government got their sums wrong and didn't realise what great value the old system offered.’

Under no cirmcumstances. Some colleagues have thought of taking back responsibility provided there was adequate funding. I think this could backfire. Even if there was adequate funding today, I am absolutely certain, government find ways of clawing it back one way or another. Look what's happened to QOF money and LES/DES funding.’

If we just did early morning and short evening surgery – manageable. But not after regular 12-hour day. I need sleep and food at sometime’

Can't work 13-hour days and do the nights as well.’

‘A return to the dark ages.’

Since 24-hour responsibility was removed there has been considerable increase in work during "in hours". As a result adding additional hours will result in increased tiredness and reduced ability to make correct management decisions. This will be dangerous. If forced to do this, my only option will be to retire as I do not want to be responsible for an error.’

When GP's had 24-hour responsibility, they would turn up for morning surgery after being on call sometimes with little or no sleep. This increases the risk of mistakes and does not allow the patient to receive the best possible care.’

Since 24 hr responsibility was removed there has been considerable increase in work during 'in hours'. As a result adding additional hours will result in increased tiredness and reduced ability to make correct management decisions. This will be dangerous. If forced to do this My only option will be to retire as I do not want to be responsible for an error.’

Undecided:

It depends on whether the government take back the time equivalent volume of work from our day-time duties. We can't do "overwhelmed" and then add OOHs on top. Or, at least, I can't and won't.’

I might consider it were the work to be adequately funded; I am not be prepared to do it in return for getting back my original opt-out money (approx £6,000 per annum) as we know it cannot be done for that sum. If that sum was insufficient to fund an adequate service in 2004, how much would be required 10yrs on? Are the government prepared to pay that?’

Partially..... - if funded appropriately (the £6000/GP was derisory and unrealistic when implemented) My suggestion would be to keep the existing out-of-hours services but via a DES task practices/partners to undertake 1-2 shifts/full-time partner a month working for the OOH services. This would ensure local high quality GPs involved focusing on reducing admissions. Doctors would get paid for the shifts and practice would get a DES payment if target of shifts done. Out-of-hours providers struggle to fill rotas and quality can be variable with locum staff. Not a mandatory DES. Please don't shoot me!’

Only with the right safeguards, practical & financial. We did it for peanuts before, unappreciated. The executive had no idea how much we did for little or no reward & how much our own health suffered. Now they know how much it costs to give the service & a less good one than we gave previously.

Well run out-of-hours services are efficient and safe and run by the GPs who WANT to do it. The problem arises when cheaper poorly run services are given the contract for this service and corners get cut.’

For:

As a GP with interest in emergency care I'd wish to be involved in this - looking at nurse/GP-led service with trained first aiders and paramedics. It worked at London 2012 Olympics (in my role as crowd doctor) - brilliantly with a TEAM. New system is needed asap. Must be flexible & staffed according to needs/demand.’

I think CCGs should have the remit to commission the service and to insist on integrated design along the lines of the old co-ops but rolling in 111 for telephone access and initial triage and setting up front-of-casualty urgent care GP provision. I would like a trial of amalgamated lists where there are many practices using the same clinical systems. That way we could create other models of care and access to care with greater flexibility and patient choice. A young fit person needing antibiotics for UTI or a cream for their rash might as well be seen anywhere that’s convenient for them.

Only if it was funded properly, allowing time off for a previous night’s duty.’

‘We can now negotiate a proper rate for the job and it will give us back our "balls" and our esteem in the eyes of the public and our hospital colleagues who view with contempt and pity in equal measure.’

It was a mistake to give up responsibility as I believe out-of-hours care has been the poorer for it. We should take it back and organise it ourselves. That doesn't mean we have to do it all!’

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