Night Shift

One of the first posts I ever did was on after hours fees. I haven’t changed my opinion in two months (has it only been that long?). I still think after hours funding should be directed at emergency departments and that A&M clinics should be allowed to charge whatever the market will bear. However, yesterday, the Independent Practitioners Association Council (IPAC) said that more funding needed to be directed at after hours service, to improve access.

As I have already said in my last blog, the issue is not access. Patients can still access an emergency department 24 hours a day. It is very unlikely that they will be turned away.

The real issue is the load on emergency departments, which is currently too high for the current staff levels – and getting worse. A&M Clinics and GP surgeries take some of the non-urgent and semi-urgent patients and reduce the ED load. Without them, the waiting time for anything less than a full emergency would probably double. It is, therefore, in the government’s interest to make sure that after-hours GP care is properly funded, if only to encourage non-emergencies not to access the emergency department. After hours care must be lucrative enough to encourage GPs to work the unsociable hours or be able to pay sufficient to locums to do it for them.

As the IPAC says, the biggest problem is in the rural areas. This is also the very place where the impact on an emergency department can be most detrimental. Most rural EDs are staffed by a single doctor and a single nurse after-hours. While most nights are very quiet, the nature of ED work is that it is unpredictable. A single doctor and nurse can be quickly overwhelmed by a sudden influx of patients into an ED. Being unable to refer some of the minor patients on to the GP service is a recipe for disaster, as staff become tired, make mistakes and take inappropriate short-cuts. Patients with the more minor ailments often find themselves waiting for hours to receive very perfunctory service. Complaints abound. Sometimes really sick people are mistakenly thought to be well.

It is important that we see this as rather more than GPs asking for more money. This is about making after-hours GP services sustainable and protecting our emergency departments from dangerous over-use.

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