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Rural general practitioners and out of hours cover

BMJ 1994; 309 doi: (Published 17 December 1994) Cite this as: BMJ 1994;309:1663

The need for a humane contract

  1. Martin Lawrence
  1. General practitioner, Chipping Norton OX7 5AA.

    EDITOR,—As the General Medical Services Committee seems to have ceased to represent the interests of rural general practitioners, I would like to open a debate on out of hours cover. Recent reports on the death of a 26 year old junior doctor who died after an 86 hour week said that he was “about to enter the calmer waters of general practice.” As a general practitioner who has spent most of the past 20 years in a rural practice of three doctors, with no possibility of sharing out of hours work, I have worked a (roughly) 40 hour week and shared cover on the remainder, making 80 hours in all. Included has been one weekend in three lasting 77 hours. Whenever on call, night or day, we must be ready to go immediately and fully equipped to patients who have had a heart attack and other emergencies.

    Four fifths of general practitioners have expressed an interest in opting out of their 24 hour commitment,1 but the GMSC has failed to implement this mandate, which will need to be done vigorously because the government refuses even to negotiate it. After all, it's cheap: the government's recent pricing of about pounds sterling 3000 per doctor would pay me pounds sterling 3 an hour for night cover and visits.2

    The GMSC's policy of retaining 24 hour commitment on a fairly uniform remuneration basis works only for those who can abrogate 24 hour continuity by using locum services or large cooperatives. Meanwhile we in more rural areas are left—to die quietly? A humane contract is not impossible: the Danes have one.


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