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Out of hours care - a round up

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6941.1388 (Published 28 May 1994) Cite this as: BMJ 1994;308:1388
  1. T Sheldon,
  2. J Roberts,
  3. A Dorozynski,
  4. M Dolley,
  5. J Siegel-Itzkovich,
  6. P Conradi,
  7. P Sidley,
  8. M Ymauchi,
  9. H Karcher

    General practitioners in Britain are taking the first steps towards easing the burden of out of hours work. Although they are still responsible for the 24 hour care of patients, they will have greater freedom to decide how they provide it. But in many countries doctors are not responsible for their patients outside of office hours and emergency care is provided in a variety of ways. In France many people call the fire department to get advice form fire officers who are trained in first aid: in Israel people visit emergency medical centres; in the US out of hours care is provided by emergency rooms in hospitals. In the poorer parts of South Africa emergency care is not available - doctors and ambulance crews will not go there after dark. We look at how out of hours care is provided in these and other countries.

    The Netherlands

    Dutch general practitioners claim that every citizen, including Queen Beatrix, is registered with a family doctor. General practitioners provide on call services as part of their contract with the sickness funds - Ziekensfonds - for which they receive capitation payments that cover two thirds of the Dutch population. The remaining one third of the population, who are privately insured, still register with general practitioners because hospital consultants will not treat patients without a referral letter form a general practitioner.

    Arrangements for out of hours cover are laid down by the Dutch College of General Practitioners (NHG). General practitioners must display information on out of hours services in their surgeries; patients should be put through to only one answering machine before speaking to a doctor; and doctors on call must have access to patients' notes. The college says that the number of home visits has fallen by half compared with 25 years ago and that most …

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