Skip to main content

Main menu

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • BJGP LIFE
  • MORE
    • About BJGP
    • Conference
    • Advertising
    • eLetters
    • Alerts
    • Video
    • Audio
    • Librarian information
    • Resilience
    • COVID-19 Clinical Solutions
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers

User menu

  • Subscriptions
  • Alerts
  • Log in

Search

  • Advanced search
British Journal of General Practice
Intended for Healthcare Professionals
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
  • Listen to BJGP podcast
  • Subscribe BJGP on YouTube
British Journal of General Practice
Intended for Healthcare Professionals

Advanced Search

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • BJGP LIFE
  • MORE
    • About BJGP
    • Conference
    • Advertising
    • eLetters
    • Alerts
    • Video
    • Audio
    • Librarian information
    • Resilience
    • COVID-19 Clinical Solutions
Debate & Analysis

Pitfalls of GPs Getting back Directly into Out-of-hours care

Michelle Drage
British Journal of General Practice 2013; 63 (615): 547. DOI: https://doi.org/10.3399/bjgp13X673865
Michelle Drage
Chief Executive, Londonwide LMCs.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info
  • eLetters
  • PDF
Loading
Figure
  • Download figure
  • Open in new tab
  • Download powerpoint

Michelle Drage

Recent ministerial pronouncements and media hyperbole around GPs being personally responsible and even personally providing out-of-hours care have sent shock waves throughout the profession. Such a reversal of an agreement that suited government as recently as 2004, is regarded by three generations of GPs as the last straw. For rural and city GPs alike, that agreement brought an end to constant battle against exhaustion, absence from family and home, marital breakup, neglect, and deterioration of personal health with no respite in sight. Demand for out-of-hours visits could not be stemmed, even by long, open-ended evening surgeries.

There was a terrible knock-on effect on daytime surgery; fatigue, decreased efficiency, irritability, increased risk of clinical error, and defensive practice. Despite our best efforts, patient dissatisfaction and complaints about in-hours and out-of-hours care rose inexorably and in an increasingly risk-averse, performance-driven environment the glue of collegiality and mutual support began to break down.

All of these are as relevant now as they were then, only more so. In-hours days are longer and far more complex than ever before, with consultation time being stretched to the absolute limit with the demands of QOF, the transfer of secondary to primary care, the multimorbidities that accompany longevity and medical advances, as well as ever-rising patient expectations and government targets.

While the GPs of the post-war baby boom era were prepared to both provide and be responsible for out-of-hours care, the GPs of the new baby boom are not. Now equal in numbers, male and female GPs are highly likely to have portfolio careers and less of a tie to life-long job security and satisfaction. They have grown up with different values in terms of work-life balance, shared parental roles, dual incomes, and other societal expectations.

Moreover, they are not trained to take back this archaic role of the clinically-unnecessary 3 am visit for earache, based on politicians’ rose-tinted memories of childhood. Nor are they prepared to take on responsibility for its organisation, in effect becoming the provider of last resort. How would they fit it into the 12-hour days they do already? How would patients receive continuity of care in hours? With doctors no longer living in the communities they serve, what about the journey times? What about the safety risk in our cities, towns, and rural highways? Who would look after the children at night when life partners are often living and working away from home to pursue their careers?

Life in New Zealand suddenly looks quite appealing, and if this notion is pursued we can expect many more GPs to pick up their families and go.

  • © British Journal of General Practice 2013
Back to top
Previous ArticleNext Article

In this issue

British Journal of General Practice: 63 (615)
British Journal of General Practice
Vol. 63, Issue 615
October 2013
  • Table of Contents
  • Index by author
Download PDF
Download PowerPoint
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Pitfalls of GPs Getting back Directly into Out-of-hours care
(Your Name) has forwarded a page to you from British Journal of General Practice
(Your Name) thought you would like to see this page from British Journal of General Practice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Pitfalls of GPs Getting back Directly into Out-of-hours care
Michelle Drage
British Journal of General Practice 2013; 63 (615): 547. DOI: 10.3399/bjgp13X673865

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Pitfalls of GPs Getting back Directly into Out-of-hours care
Michelle Drage
British Journal of General Practice 2013; 63 (615): 547. DOI: 10.3399/bjgp13X673865
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
  • Figures & Data
  • Info
  • eLetters
  • PDF

More in this TOC Section

Debate & Analysis

  • SAFER diagnosis: a teaching system to help reduce diagnostic errors in primary care
  • An Australian reflects on the Collings report 70 years on
  • Emergencies in general practice: could checklists support teams in stressful situations?
Show more Debate & Analysis

Out-of-hours care

  • The Role of Patients
  • How Primary and Secondary care should work Together
Show more Out-of-hours care

Related Articles

Cited By...

Intended for Healthcare Professionals

BJGP Life

BJGP Open

 

@BJGPjournal's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Current Issue
  • All Issues
  • Online First
  • Authors & reviewers

RCGP

  • BJGP for RCGP members
  • BJGP Open
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers

MY ACCOUNT

  • RCGP members' login
  • Subscriber login
  • Activate subscription
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP: research
  • Writing for BJGP: other sections
  • BJGP editorial process & policies
  • BJGP ethical guidelines
  • Peer review for BJGP

CUSTOMER SERVICES

  • Advertising
  • Contact subscription agent
  • Copyright
  • Librarian information

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7400
Email: journal@rcgp.org.uk

British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners
© 2023 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242