Seeking a sustainable solution to the costly mess of GP out-of-hours care

Your analysis of the GP out-of-hours situation is accurate – but only in so far as it goes (your report and editorial, 16 January). There are several points that should be clarified.

The new contract of 2004 actually passed responsibility for providing out-of-hours care to health boards – the government agreed to this (it is, after all, its contract). When my practice offered to organise its own out-of-hours set-up for a modest rise in practice income, this was rejected by our local board. So whose fault is that?

All the other professions you mentioned do shift work and that is how they cover unsocial hours. This was never offered to GPs. The majority of full-time GPs who opted out of out-of-hours work continue to work 50-60 hours a week. Should they also be expected to do out-of-hours work? If not, where are we to find all the extra GPs to make the system work?

When I did my own on-call, I was doing more than 1,000 hours a year on top of my usual 50-plus hours working week, for which I was paid £3,000 a year (less than £3 an hour). So in opting out I actually lost twice as much money as I earned from out-of-hours. Are you seriously suggesting we return to that situation?

What most people fail to realise is that opting out of out-of-hours work was never actually about money. It was about the pernicious and corrosive effects of the previously accepted system on the personal, family and social lives of doctors, and I cannot see many of them rushing back to that scenario.

(DR) STEPHEN McCABE

Fancyhill

Portree, Isle of Skye

As you correctly state, the new GP contract was badly needed – morale was low and recruitment falling due to chronic underfunding and unacceptable terms and conditions imposed by the government in the 1990 contract.

This new contract has been hugely successful. Practices have performed magnificently and the impact on outcome for patients with chronic diseases has been startling.

The contract's effect on out-of-hours care seems to be poorly understood.

The majority of practices were covered by out-of-hours co-operatives before the new contract, which simply formalised this system and made it available to all practices. The only real difference is that, under the old system, GPs actually paid to work in the co-operative. My practice was one of a minority which continued, until 2004, to provide cover for its own patients as part of a group.

The relatively thin spread of GPs across rural areas meant heavy on-call rotas, which was not sustainable. My predecessors in the practice could cover for days on end without difficulty – calls from patients were infrequent and, on the whole, confined to real emergencies. By the time I finished in 2004, the situation was different – I dreaded coming to work on a Friday morning, knowing I would not finish until Monday evening, with constant work over the whole weekend.

You state that GPs must expect to do some out-of-hours work. In fact, it's not reasonable to expect someone doing a full-time job by day to work night shifts too. What is happening now is that some GPs work only out-of-hours, some work part-time during the day and part-time out-of-hours, and some work full-time during the day and a limited number of out-of-hours sessions. Many, like myself, work full-time by day and do no out-of-hours work.

The new GP contract is working well for everyone. It's a pity the government and the press don't want to recognise this and build on it.

(DR) ROBERT W LIDDELL

Balmellie Road

Turriff, Aberdeenshire