Confused, as have many, by the Out of Hours section of the BJGP, it was good to see a piece that actually was about out-of-hours (OOH) care.1
In many ways, it was the patient and secondary care views that best summed up the problems we face in OOHs. Because of the lack of shared care record access, we are ‘blind’ in OOHs and this significantly raises risk, encourages defensive medicine, increases costs, and prevents us giving the best service possible. Despite what is often said, it is not the IT that is the problem but management and primary care involvement that is at fault.
Professor Mason rightly raises the issue of the large numbers of patients who inappropriately attend A&E. Most of these do need medical care but not necessarily of a secondary care nature and around 40% of those turning up at A&E would be best managed by a primary care practitioner be they a nurse, GP, or paramedic. Collocation is a far better answer than the ineffectual NHS exhortations to attend A&E appropriately. Numerous pilots and ongoing facilities have proved this time and time again.
Among the hype and hysteria on both sides regarding primary care ‘taking back OOH care’ is a kernel of truth. Primary care does need to get more involved, at least, in making sure that the service that is provided is up to their own and their patients’ standards. It has to be remembered that the service pre 2004 did not have any of the developments, both in provision and governance, we have now, and we are all the better for that. The dewy-eyed picture of GPs visiting their own patients only, hardly ever existed pre 2004.
The work in OOHs is different when compared to the daytime chronic disease management demands but many of the skills needed are interchangeable. I do think Dr Greenhow has a point in sharing best practice and striving to achieve the highest standards and, as members of Urgent Health UK, we work hard at doing just that. As for the buddy system, I am not sure how that would work and would be, I would imagine, prohibitively expensive.
OOHs will always need better funding but better primary care involvement and innovative ways of working, based on good evidence, would help to give the high standard of service we all want to provide.
- © British Journal of General Practice 2013
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