Out of hoursBMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6969.1593 (Published 17 December 1994) Cite this as: BMJ 1994;309:1593
- Brian Hurwitz
Primary care needs a properly funded, well organised night time service
In the London practice where I trained as a general practitioner in 1982 the doctors made all the out of hours home visits every day and night of the year. They believed that continuity of care and the insights offered by dealing personally with requests for home visits were distinctive responsibilities of general practitioners.
A senior partner from this practice recently told me that a commercial deputising service now handles all out of hours calls (those made from 10 pm on weekdays and 6 pm at weekends). His views have changed: he believes that being on call out of hours is unprofessional. It betokens a serious failure to maintain personal and professional boundaries, and encourages doctors to develop self destructive fantasies of omnipotence and omniavailability. He no longer feels able to justify the effects of disturbed sleep on clinical performance during the day or on family and working relationships.
Despite the growth of the 24 hour society such an about turn in attitude by general practitioners is common. Rarely has more unanimity been expressed by British general practitioners than in their views towards present contractual requirements for providing 24 hour general medical services under their NHS terms of service. A consultation …