Airline pilots and pizza delivery boys work all hours. How arrogant of GPS to think it’s beneath them

BACK in the Seventies, when I was a 24-year-old doctor working at a GP clinic in Barnes, SouthWest London, our surgery was dedicated to caring for people of all ages, at all hours, on all the days of the week.

It was not a million miles from the TV world of Dr Finlay’s casebook, where the dedicated team involved an older, experienced GP, a keen young assistant doctor and a highly involved admin secretary.

Work took me blearily out of my bed at some of the most anti-social hours imaginable. I recall standing in a tiny garden at 5am on a summer Sunday morning watching hot air balloons rising over Putney Common and holding a newborn baby following its delivery in a tiny house in Mortlake, having stitched up the mother while holding a torch between my teeth.

That was an experience I will always value. Mother, baby, and I — if you will allow me a modest boast — did well.

Working out of hours could be tough, annoying and dull. But it was also memorable and hugely rewarding.

From the earliest days in my career as a doctor, I was involved in everything from a murder scene to caring for the dying at home.

Nowadays, all that has changed because GPs have given up on their moral duty to provide out-of-hours care.

In England, the out-of-hours service is so short of doctors that the highly controversial companies charged with running them are offering locum GPs up to £1,350 per shift to cover evenings and weekends. Often, only nurses are available for outof-hours cover in areas as large as 150 square miles.

If you are a patient in desperate straits outside normal working hours, you can no longer simply call your GP. Instead, you have to try ringing a call centre — where you might eventually get through to an overtired, underqualified hiredhand doctor with a titanic caseload and no understanding whatsoever of your personal circumstances.

England also has a new 111 helpline for out- of-hours care that is so hopeless that every month, tens of thousands of patients in search of a doctor hang up in despair because there is no response.

The result of this catastrophic neglect of our out-ofhours service is that desperate patients with nowhere else to go are pitching up at Accident & Emergency units all over the country in their millions - and, in the words of one senior doctor last week, turning them into ‘war zones’ which simply cannot cope.

Scottish Labour’s Johann Lamont this month spotted a straw in the wind that may presage a Scottish A&E crisis when she pointed out that waiting times are rising ominously.

ADMISSIONS to English A&E units have risen by nearly 60 percent in a decade to 22 million per year, and a report by the College of Emergency Medicine said this week that up to 30 percent of them - that is 6.6 million people every year - are arriving at A&E when they do not need to.

There are stories of patients turning up with nits, or veruccas or flu, even looking for repeat prescriptions. Doctors at King’s College Hospital, London, for example, have reported patients at their A&E department wanting treatment for cold symptoms, hayfever, splinters and ear-ache, among other injuries and illnesses. This is going on at A&E units across Britain.

Meanwhile, those who really do need emergency help are not getting it. The College of Emergency Medicine warns that A&E units at night are desperately short of experienced doctors and left in the hands of juniors.

‘Because of the pressures, an increasing number of units are at times probably unsafe,’ says the college’s vice president Dr Taj Hassan.

You cannot really blame the patients - they are caught in an i mpossible Catch- 22. Because doctors have given up on traditional out-of-hours care, people flock to A&E. Yet the A&E units don’t have anything like enough clinicians - because so many doctors refuse to work outside normal hours and regard a job in casualty as too stressful.

As Katherine Murphy of the Patients Association says, the crisis in A&E can be traced back to a ‘complete lack of faith’ in local GP out-of-hours services.

That this appalling situation was ever allowed to develop is little short of criminal. And it is down to a combination of greedy, workshy doctors and an arrogant but naive Labour government which ignored warnings about the impact on patients when it negotiated a new contract for GPs in 2004.

To truly understand why it has all gone so disastrously wrong, we have to wind back the clock.

In the old days, if you were ill outside normal working hours, you could call your surgery and your family doctor would come round to see you.

But the EU’s Working Time Directive in 1988 - which limited work in Europe to a 48hour week - gave doctors new ideas.

They complained the hours they put in outside the normal working week were undervalued by government, and that some patients were abusing the system by calling doctors out for frivolous reasons.

By the early 1990s, GPs’ surgeries were offering pooled care across l ocal regions, which meant you lost the right to a home visit from your own family GP.

Then, in the negotiations running up to the 2004 contract, the all-powerful doctors’ union the British Medical Association ran rings around the government, persuading ministers to allow them to drop GPs’ obligation to provide an out- of-hours service for a minimal reduction in pay.

Meanwhile, the BMA negotiated a means of more-than making up the shortfall.

For the contract also introduced a series of well-meaning but hopelessly flawed targets designed to improve the health of the nation. Doctors were told to weigh all their patients, to take cholesterol and blood pressure readings, and conduct all manner of other tests. And they were paid, of course, for each test they carried out; for each target they met.

Before long, these lucrative box- ticking exercises were taking up so much of their time that they had no time for old-fashioned doctoring. It was no longer possible to see your doctor as you used to, whether out of hours or down at the surgery. That essential relationship between an individual GP and his patients was lost.

The traditional GP used to be the pivotal person in the delivery of care. But the effect of the new contract has been to reduce the doctor to a cog in the machine - and a very expensive one at that. GPs salaries have increased by some 45 percent since the contract came in, and now average around £110,000.

Today’s new GPs never have to do out-of-hours house calls, and don’t develop a close relationship with their patients - and that loss is disastrous.

A traditional family doctor providing continuity of care understands the household dynamics. If, for example, you know there is a daughter who is misusing drugs, then you can better understand why the father is getting stressrelated ulcers, and you are in a far better position to provide the right care.

Research shows that patients can recover significantly faster if they have a GP who spends time with them, who listens and is supportive, because it leaves them feeling more confident in their care and better able to do what’s needed to assist their recuperation.

YOU can’t possibly get that down a phone line from an understaffed and underqualified operative in a call centre. And instead of getting personal counselling, patients are now often directed to some kind of psychological support website. People just get sicker that way, and in the end it costs the NHS a lot more.

The vocation and the art of medicine has been sacrificed for short-term economic gain, as measured by ticked boxes and statistics.

GPs signed that 2004 contract with pound signs in their eyes, and the chaos now being visited on the out- of-hours care system - as well as our crisis- hit A& E units - i s the result.

We doctors have got to think again. We need to create new rotas of some sort, so that GPs all share out-of-hours care and ensure it is delivered professionally and sensitively.

Hospital consultants have recently agreed that they need to work in hospitals at weekends, because it is then that a great deal of illness occurs.

Surely GPs can do the same with out-of-hours care? Everyone else has to work all kinds of hours nowadays, be they an airline pilot or a pizza delivery boy. Why should GPs think they are so special that they can put themselves above the crucial needs of patients?

DR MARTIN SCURR writes the weekly As A Doctor column in the Daily Mail’s Good Health.