Out of Hours Care

1. Out of Hours Care Past present and future Heidi Wright Sept 09

2. Past • 24 hour care by “own” GP

3. History locally • Previously we did our own on call • Call out frequency was very varied but often less than 5 calls overall • By 1997 the coop had been established

4. Co-op aka DMS • This was initially staffed by local GP principals…(and registrars,being supervised) • Monthly commitment was 2 shifts and 2 standbys or 3 shifts, a shift being 4 hours day time to 11pm or an overnight ( no EWTD to complicate things!)

5. 2004 • New GP contract negotiated nationally • Meant GP practices could opt out of OOH care after 1830h • Cost to an individual- £6k a year • Could happily opt in to continue working for the co-op • PCTs were now responsible for OOH care provision not the GP

6. 2004-2009 Locally • NHSd launched • Far fewer local principals working for OOH and more from elsewhere in UK and EU • Development of the role of an ECP • Development of the Walk In centre • Change from “DMS” TO “DHU” with expanded roles and area covered

7. Future? • Probably more of the same • Possibility of a change in government leading a change in OOH care • Will there be an extension of core hours agreed nationally?

8. Elsewhere • Be aware of different care models especially in Rural and Remote areas • Eg Highland and Islands of Scotland; Wales • Often GPs superbly well trained in pre-emergency care with regular BASICS/ATLS etc courses • V difficult to get cover, utilisation of other healthcare workers being brought in, transfer times longer etc.

9. TOP TIP • Remember to add this to your e-portfolio and link to curriculum statement on OOH!