Out of hours care: a new way forward.

There is an increasing expression of concern in the medical literature, of the impact of providing out of hours care on the quality of life of the GP. This has resulted in a series of articles seen recently in the weekly publications received by doctors. Public demand for out of hours primary care is increasing 1.3. This has generated a 25% increase in night visits as claimed by GPs contracted to provide General Medical Services (GMS) care in the Eastern Health Board(EHB). This increase was similar in the Southern Health Board. General practice is not alone, as seen in a recent report by Dr Mary Hynes (EHB) , as she demonstrated a 5.6% increase, per annum in attendance at Casualty Departments. over a period of five years. Stress generated by an ever increasing public demand on General practice is considerable, and has been the basis of a national survey published recently by Prof. Tom O'Dowd in conjunction with the Irish College of General Practitioners. Prof O'Dowd has highlighted that one in three GPs consider themselves to be stressed or very stressed. The impact was greater on male GP's, where almost 50% consider themselves either under stress. or very stressed. Amongst the causes are: I. Difficult patients: 20% 2. Excessive workload 19% 3. Out of hours care provision: 15% The Irish Medical Organisation retains the aspiration and negotiating position that in the near future GPs will no longer have a 24 hour, all year personal responsibility for patient care. They seek "that GPs will have the option to contract out part of this responsibility". The MANCH group of hospitals are relocating to Tallaght and whilst a group of academic and other interested parties including the EHB are attempting to measure the impact of this • there is little doubt that there will be an increase in patient demand, (if only in the medium term) for out of hours care services provided by local General Practitioners, (in the immediate vacinity of affected hospitals)