GPs pulling out of af­ter-hours calls

The Weekend Australian - Travel - - Health - Adam Cress­well

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

Pic­ture: Bob Fin­layson

Quandry: Aline Smith with pa­tients Danielle Young and daugh­ter Char­lotte. Smith is weigh­ing whether to dis­con­tinue af­ter-hours calls

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