I run an extended hour (16 hours/day) GP clinic in tropical oz. It is
largely funded by the local version of "NHS".
An overwhelming observation is that it is treated like extended hours
shopping or petrol. People come at times convenient to themselves (and see
the after hours doctors), for things that are much better sorted out during
9-5 daytime and that would work out better for them if they'd had the
continuity of care of seeing the same doctor as previously. Doctors tear
their hair, but patients are quite unperturbed by all these things.
We have a pharmacy on the premises for all the 16 hours. Radiology and
pathology are present for 8 hours per day, and available on call for the
rest. We can even get x-ray reports after hours because we have a high power
scanner with ISDN line to a radiologist's home.
The whole thing is enormously popular with the patients, and not very
popular at all with other GP practices in town. Some have even hinted that
we must be doing something "unethical" to be so popular. They just cannot
see that the reverse is true. We are so busy, that the moment somebody tries
to pressure us into an improper action, we can suggest they see another
medical practice, knowing that our income will be unaffected.
I can see many problems with this style of practice, but it can be
economically viable. I can't quite see why the after hours co-op in UK
cannot be extended into a similar idea. What is the rationale behind
everybody scurrying off to their own surgeries during the day? (Or is that a
silly question?) One of the advantages of the larger centre is the improved
standard of building, equipment, management etc than can be afforded as the
costs are spread over so many more consultations.
~~~~~~~~~~~~~~~~~~~~~~~~~~~
Stephen Crawshaw
Townsville, Australia.
~~~~~~~~~~~~~~~~~~~~~~~~~~~
-----Original Message-----
From: Stuart Skeates
>On Sunday, September 27, 1998 10:31 PM, Jeff Green
>[SMTP:[log in to unmask]] wrote:
>
>> Dare to think about change. What is wrong with a system of surgeries open
>> all hours, salaried doctors working shifts, with higher rates of pay for
>> working late, bank holidays etc?
>>
>
>In principle there is nothing wrong with it. However you are talking to
>doctors whose total experience of 'open all hours' means that whoever is
>doing the day shift does the night as well. Our contracts are for 24 hour
>cover even though we use COOPs etc for out of hours cover. A&E is about the
>only department that has properly run shifts with each doctor only
>responsible for a few hours of the day.
>
>Patients of course would loose continuity of care but then maybe we place
>too much emphasis on that aspect of our care. It may be more a want than a
>need.
>
>Stuart
>
>
>
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