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I sighed. Glasgow's tower blocks, heavy skies, and the sprawling postwar housing schemes that aimed to offer a better life than did the inner city slums disappeared in my rear view mirror. We headed for a better life in rural Suffolk, where I had taken up a GP partnership. The move from the electoral wards with the shortest life spans in Britain to those with the longest was just an eight hour drive. All my training, however, had not prepared me for the reality of general practice.
Fifty consultations every day, five house calls at lunchtime, call-outs in the midst of surgery, 7 pm finishes, Saturday morning surgeries that ran till 3 pm. But I considered myself lucky, for the fledgling out of hours cooperatives had freed us from the 24 hour commitment that had crushed previous generations. I struggled, suffering near constant chest pain induced by stress. This was the 1990s: the Great Depression of general practice. Recruitment was at an all time low, and partnerships were worthless, receiving no applicants. It was a bankrupt specialty standing on the edge of the abyss, and the term “burn-out” was on everyone's lips. Desperation forced change in Suffolk, and we reorganised. But that was the past, and general practice is now booming.
The government wants to extend general practice opening hours into the evening and weekends. For many this is a step back into the darkness of the past and to be resisted at all costs. But our working lives have been transformed by the new GP contract, so we owe our patients and the government an opportunity to explore these suggestions.
If these plans were not about offering more appointments but merely offering different times of availability this would suit many practices, with no need for coercion. With out of hours services covering emergencies during weekends, early mornings, and evenings, standard routine appointments could be offered at these times. The traditional two session day could be extended to a more flexible three session day, offering GPs the possibility of an early start and early finish or a later start and later finish—or even swapping a weekend morning for a midweek session. Such flexibility is much more compatible with family life. Extended opening may present problems with support staff; but with the development of paperless records systems and online booking the need for clerical staff is in steep decline. Offering extended opening is simply an issue of organisation—it is in our interests and possible. What goes around comes around.