A disastrous mistake was made in 2004 that needs to be remedied. The health secretary at Westminster, John Reid, signed off on an agreement with the BMA to create an option for GPs to give up their long-standing practice of providing out-of-hours care.
By 2009, in Scotland, 95 per cent had given up working out of hours. This left a scattering of dedicated doctors in parts of the Highlands and Islands who, by sharing duties and employing locums, kept going 24/7. Otherwise, the out-of-hours responsibility was assumed by health boards.
I was one of the witnesses in 2010 when the Scottish Parliament’s Health and Sport Committee took a look at rural out-of-hours healthcare.
By and large, the official witnesses endorsed the new status quo, seeing it as opening the way to more integrated forms of care.
But there were signs that things were not going well, that there was over-reliance upon NHS 24 and that A&E services in particular were being stressed by having to treat many patients out of hours who should have been seen by a GP.
The committee report in May 2010 recognised that public confidence had been lost.
Since then GPs’ financial positions have worsened and many of them are seriously overworked. We must hope that the new review will help to restore GPs to their previous position of responsibility 24/7 and advise how they can be given the recognition, resources and support that they need. Maybe it is time to negotiate a new GP contract, this time just for Scotland.
Rannoch by Pitlochry
I read with interest your articles about the out-of-hours problems caused by the changes in the GP contract.
The government investigation is something that should have been done long before this.
The present method of dealing with calls which, in the past, would have been dealt with by the duty doctor in a particular practice or area are now taken at a switchboard and after a varying amount of time, advice as to what to do next is relayed to the caller.
Out-of-hours on-call was always a bind, but it could also be very rewarding and for much of my career, was considered to be part of the job.
It will be very difficult, if not impossible, to get the majority of the profession to revert to doing out-of-hours work.
I also wish to comment on the comment column of Dr Jenny Bennison (same day). I am not doubting her hard work and long hours, but I am amazed about the number of telephone consultations in one day and the reading of 50 letters.
Perhaps a more regular study of the incoming mail would help.
It was interesting that she did not work on Mondays; it was, in my time, often the busiest day of the week.
The weekends, in particular Saturdays, were not mentioned, but as very few practices open on a Saturday, is it reasonable to assume that she is doing a four-day week?
In the profession, we used to have a saying that “he believes his own horror stories”. Maybe we have a case of this here.
Genuine complaints can be ruined by overstating the case.
(Dr) Robert J Abernethy