Out of Hours Cover

Strachur is over an hour from the nearest Accident and Emergency Department (Inverclyde or Paisley RAH(1)) and around 25 minutes from the nearest ambulances (Dunoon and Inveraray) and Minor Injuries Unit (Dunoon).

Currently we provide 24/7 emergency cover 365 days a year for anyone in the Strachur practice area (from the Rest and Be Thankful to half way down Loch Eck). The new GP contract allows GPs to 'opt out' of 24 hour cover, and currently the Strachur Medical Practice is one of the few GP practices in the UK that has not opted out.

The opt out has been popular with the vast majority of GPs because of the costs of providing 24hr cover. The cost of getting a locum doctor to cover the Strachur practice is between £1000 and £1750 for a weekend and between £100 and £400 for a night on call (£78,000 to £195,000 per year). But the Health Board only pays the practicE around £20,000 to provide the service, so a few bills for locums to provide weekends off and we end up making a loss!

The main problem with providing 24hr cover is not the number of calls that we receive. Unlike town or city practices we receive only a small number of out of hours calls and the vast majority of those calls are genuine emergencies. The problem is the nature of the on-call itself. Unlike an on call district nurse (we don't have one in Strachur), or most other on call jobs, the doctor is on call for life-threatening emergencies. In some cases, seconds can literally mean the difference between life and death for a seriously ill patient. I respond to such Category Red calls with a green light fitted to the car, and have special emergency training to deal with all types of medical emergency. This means that the car boot is full of emergency equipment (no room for shopping!), and I have to be careful when I have my wife and/or child in the car - emergency driving can mean sudden stops, which are not ideal for pregnant women and children, I can't just pitch up at a serious road accident and leave them in the car!(2).

The other main problem is communications. Pagers don't work in Strchur or the surrounding area(3), and mobile phone coverage is variable (I was really annoyed we missed the recent Bluegrass concert because there is no mobile reception in the Village Hall). To complicate matters, when I took over the practice I discovered that the phone system installed in the practice is so old that you can't use an answering machine with the practice phone line(4). So there is all the stress of worrying that people will actually be able to contact you when someone has a massive heart attack, or crashes their car into a tree. In my experience, the worst calls always happen when the mobile phones have gone down, or a power cut has knocked out your answering machine. The idea of one of my patients dying because I they could not contact me literally keeps me awake at night. And of course, there are no banks, cash machines or large shops in the practice area, A trip to Dunoon means constant worry about 'is the mobile working', 'how quickly can I get back to the car if I have to run', 'what will Ellie and Mirrie do if I have to abandon them?', and a trip to Ikea could lead to being struck off by the GMC for leaving my patients without adequate medical cover.

In some ways the stress is actually worse because genuine emergency calls are infrequent - emergency equipment is more likely to die unnoticed in the back of the car when it is only used once every couple of months than when it is in daily use. The same is true of emergency drugs going out of date, or batteries failing.

Having written all of the above, I'm asking myself why I would be stupid enough to continue to provide 24 hour cover! We have thought about dropping it, but of course we feel a duty to provide a safe service for the community and our patients. I don't think NHS 24 is a safe service that I can recommend to patients (more of that in a later blog), and I think Dunoon is a long way away to have the nearest doctor/ambulance if you are having a heart attack in Strachur. Besides, the Dunoon doctors are not very keen to cover Strachur, as they think it's a long way too. Plus, I've spent the last eight years doing this kind of on call, and I enjoy emergency work.

So, in an emergency call the practice number and a message will tell you which number to contact the doctor on (either myself, Dr Wright, or one of our locums). In case of dire emergency, if the phones fail, call an ambulance first, then send someone to look for us - either at Strachur House or Manse Gardens.

(1) The Vale of Leven is about 45 minutes from Strachur by road, but has had its Accident and Emergency Department downgraded, and the ambulance crews now bypass the Vale to go to Paisley RAH.

(2) At a road accident, the first emergency vehicle on the scene parks in the 'fend off' position so that if any other car should crash into the scene, they hit the fend off car and not the rescuers working on the injured - not a safe place to leave a 2 year old or a pregnant woman.

(3) The old BT pagers used to work here I think, but BT has since shut down its pager network. The remaining networks (such as Vodafone paging) don't work in Strachur.

(4) The new PBX phone system is sitting in the practice and waiting for an engineer to come and instal it.

Photo: providing emergency cover with emergency BASICS vehicle in Kinlochbervie, October 2000