Looking back to when I did my own practice on call and what OOH
services are now provided in my area (which is probably exceptionally
good), there is no comparison. Quite simply in the old days OOH care was
casual, poorly recorded, non evidenced based and at times dangerous. There
was collusion between doctors and patients that they knew each other.
Computers have shown that actually GPs did not know their patients. They
maybe knew them as people but they did not know their PMH, drugs and
detail of recent investigations. Patients presented late because, "they
did not want to bother the doctor".
In my area patients get a professional reception service, medical or
nursing triage and options to attend a centre or a home visit if required.
The visiting team have a bespoke car and equipment and all records are
computerised with access to some past history and medication.
Urgent care is often best approached by assuming you know nothing about
the patient. That way you are not tempted to make assumptions. Bespoke OOH
organisations probably do this better than patients own GPs.
We are more risk averse and rightly so. Early intervention can make a huge
difference to outcome. This does not necessarily need admission but does
need pathways which enable serious treatable disease to be excluded
rapidly and with the least anxiety.
There is more acute pathology around in my view. 10 years more life means
10 years more potential acute illness. There is a vast amount of old age
palliative care about which was not there 20 years ago.
The full time comments are relevant but daytime GP has become top heavy
with "clinical admin" which GPs are drowning in. Standards of care are
actually much higher than even 10 years ago. This rise in standards has
been achieved by more time input. Most GPs feel that a 5 day full time
week is no longer doable, yet alone adding any OOH work as well.
There are lots of complex issues with emergency admissions. There are
solutions which should be pro-active and imaginative. "Things not being as
they used to be" is not really a solution as such.
Rapid Response:
Clock Cannot Be Turned back.
Looking back to when I did my own practice on call and what OOH
services are now provided in my area (which is probably exceptionally
good), there is no comparison. Quite simply in the old days OOH care was
casual, poorly recorded, non evidenced based and at times dangerous. There
was collusion between doctors and patients that they knew each other.
Computers have shown that actually GPs did not know their patients. They
maybe knew them as people but they did not know their PMH, drugs and
detail of recent investigations. Patients presented late because, "they
did not want to bother the doctor".
In my area patients get a professional reception service, medical or
nursing triage and options to attend a centre or a home visit if required.
The visiting team have a bespoke car and equipment and all records are
computerised with access to some past history and medication.
Urgent care is often best approached by assuming you know nothing about
the patient. That way you are not tempted to make assumptions. Bespoke OOH
organisations probably do this better than patients own GPs.
We are more risk averse and rightly so. Early intervention can make a huge
difference to outcome. This does not necessarily need admission but does
need pathways which enable serious treatable disease to be excluded
rapidly and with the least anxiety.
There is more acute pathology around in my view. 10 years more life means
10 years more potential acute illness. There is a vast amount of old age
palliative care about which was not there 20 years ago.
The full time comments are relevant but daytime GP has become top heavy
with "clinical admin" which GPs are drowning in. Standards of care are
actually much higher than even 10 years ago. This rise in standards has
been achieved by more time input. Most GPs feel that a 5 day full time
week is no longer doable, yet alone adding any OOH work as well.
There are lots of complex issues with emergency admissions. There are
solutions which should be pro-active and imaginative. "Things not being as
they used to be" is not really a solution as such.
Competing interests:
None declared
Competing interests: No competing interests