Attitudes are evidence of change

Editor-The formation of an out of hours cooperative in our large rural area has prompted a great deal of anxiety and concern among those likely to be affected. The cooperative has offered both descriptive and statistical evidence for its claim that life for general practice doctors has become so intolerable that few if any can be drawn to the profession in areas such as ours.

Perhaps that is so. But there is evidence of other kinds of change as well. In 1994 Hallam referred to “25 years of decreasing personal commitment [by general practitioners] and increasing reliance on rotas and commercial deputising services.”1 Time spent on call out of hours by general practitioners had become a shrinking component of their workload, and by 1994, 57% of all general practitioners thought 24 hour care outdated.1

There is a problem, however–the patients. Many a university teacher, such as I am, has been known to say in an off moment: “This would be a grand job if it weren't for the students,” and we perhaps should not be too surprised if doctors say the same thing about patients. Out of hours cooperatives have increased from under 10 in 1991 to perhaps 140 today, “without reference to patients' views, with no attempt to involve users in their planning and preparation, and with limited efforts to assess patient satisfaction.”2 That serves pretty well as a description of the exercise we are witnessing–not participating in–today.

Nothing has struck me more about our cooperative's proposals than the arrogance of its presentation, its failure to understand the appeal to consult with the users before starting the scheme, and its refusal to delay implementation to permit such consultation. These attitudes, it seems to me, stem from another era altogether, long predating the general practitioners of today …