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- Page navigation anchor for On – call 20 years agoOn – call 20 years agoThe organisation and responsibility for out of hours Primary Care has again become highly topical. The present system has been criticised in part for contributing to the current Winter crisis in Accident and Emergency departments across the country. As well as, arguably, the failure of new initiatives such as ‘admission avoidance’ and replacing NHS Direct with another new arrangement, phoning 111 as a single point of out of hours access. Neither has had impressive results.I looked at my data kept from 1996, almost twenty years ago when I worked a regular Sunday over night shift (midnight to seven am) for ‘Healthcall’. I was a lone GP covering Bournemouth and Poole conurbation and surrounding area, long before the creation of Emergency Care Practitioners (ECP’s). It was then official policy to always visit and also to rarely call the second on-call GP. Other than a GP, there was a duty night sister exclusively concerned with nursing care needs.That year I worked 51 Sunday nights, visited 552 patients (average 11 per session, range 5 – 19) and admitted 29 (5.3%) to hospital. There was a predictable spectrum of problems familiar to all GPs with the added challenge of almost never knowing the patient and with minimal available background medical history. From physical illness, psychiatric conditions (1 in 20 cases), social problems to practical procedures such as cathete...Show MoreCompeting Interests: None declared.