GPs pulling out of after-hours calls
the middle of the night — are taking their toll. The practice is discussing whether to keep the after-hours service going any longer.
‘‘ It just takes its toll — it’s just very difficult to go out and see patients in the middle of the night, and then front up to work at 8am the next morning,’’ Smith said.
Each of the five doctors takes turns to be on call for a week at a stretch. Usually that involves fielding calls at night and giving advice on the phone. The number of calls varies between two and 10 per week. There are more calls in winter, when in busy weeks a doctor might have to get up in the middle of the night to home visit almost every night.
Medicare does not pay for consultations conducted over the phone, so to discourage unnecessary or trivial phone calls, the practice pays to route calls from patients through a premium-rate service, which means that the calls cost patients $5 a minute. Smith said the practice was trying to find a cheaper alternative.
If doctors do go out, patients are charged between $150 and $180, of which a substantial amount ($132.55 between 11pm and 7am, or $112.50 from 8pm to 11pm) is rebated by Medicare. Pensioners, nursing home residents and health care card holders are bulkbilled.
Smith said the practice was considering stopping its after-hours service after 10pm, and referring patients to a deputising service, because it was ‘‘ bloody hard’’ to keep it up.
‘‘ It’s not a money-making exercise, it’s a goodwill exercise,’’ she said. ‘‘ We know of several cases where patients who needed after-hours care and either went to hospital or had a deputising service come to them, and they didn’t do a good job.’’
Kate Carnell, CEO of the Australian General Practice Network, which represents the 119 ‘‘ divisions’’ or local groupings of GPs around Australia, said while the federal Government had made a number of grants under its ‘‘ Round the Clock Medicare’’ program to set up after-hours services in local areas, these were too few to offset the trend away from GPs doing their own services.
While deputising services were better than no doctor at all, they could not offer continuity of care because unlike the patients’ own doctors, locums would not know the history or have access to medical records.
Carnell said part of the drift away from after-hours was due to workforce shortages, and GPs finding it hard to cope with packed waiting rooms in the daytime without working at night too. Security was another issue, particularly given the increased number of young, female GPs who felt less safe visiting strangers at night.
‘‘ It’s about younger GPs wanting work/life balance and to spend time with their families; and it’s about our older GPs saying, ‘ Look, I’m 55, I want to calm down a bit — not do more and more,’’ Carnell said.
‘‘ The younger end of the spectrum is interested in lifestyle — they are telling us they are not willing to work 70 or 80 hours a week and not have a social life, and not have a drink, because they are on call.’’
MORE general practitioners are pulling out of after-hours care and farming it out instead to deputising services — locum agencies whose doctors do not know the patient and have no access to their medical records.
Increased demand from patients, the ageing of the GP workforce and the national shortage of family doctors are all contributing to the phenomenon, which is leaving many GPs too drained to continue offering their patients the option of ringing them at all hours.
Latest statistics show the proportion of GPs who provide their own after-hours care, either directly or in partnership with other nearby practices, has fallen by about 19 per cent over a three-year period, tumbling from about 58.1 per cent of GPs in 2000-2002 to about 47.2 per cent in 2005-07.
The figures — based on results from representative samples of GPs, carried out by the BEACH (Bettering the Evaluation and Care of Health) project, run by the Australian General Practice Statistics and Classification Centre at the University of Sydney — also showed an even bigger drop in GPs doing after-hours themselves.
This category fell by about 20 per cent over the three-year period — from about 43.6 per cent in 2000-02, to just 34.3 per cent in 2005-07.
Instead of being able to see their usual GP, more patients are referred to deputising services, or being advised to go to the nearest hospital emergency department. The trend away from after-hours care means over half of GPs (52.8 per cent) now either use a deputising service or tell patients to visit their nearest hospital.
Associate professor Helena Britt, director of the General Practice Statistics and Classification Centre — a collaborating unit of the Australian Institute of Health and Welfare — said the drift away from afterhours by GPs reflected a number of factors, including a desire across all types of workers to achieve a better work-life balance.
‘‘ People want their freedom — they want their time out,’’ Britt said.
Sydney GP Aline Smith is one of a fastvanishing breed of GPs who still does her own after-hours home visits. She and her four colleagues have been doing their own after-hours visits from their practice in Leichhardt, in the city’s inner-west, for the past eight years. They say it has been highly popular.
However, the strains of taking phone calls at all hours — and sometimes going out in
Quandry: Aline Smith with patients Danielle Young and daughter Charlotte. Smith is weighing whether to discontinue after-hours calls