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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 October 20; 335(7624): 792.
PMCID: PMC2034692

74 year old GP refuses to take part in deputising service

A long running dispute over working practices between the Dutch medical authorities and a septuagenarian general practitioner, portrayed as a cause célèbre for older people's rights, is to go before the Netherlands' highest administrative court.

The Council of State, which advises on legislation and governance, will judge whether a 74 year old can be stopped from working as a GP if she refuses to join colleagues in out of hours deputising services. Dr Tonny Bakhoven from Driebergen near Utrecht says she prefers to see her patients herself during nights, weekends, and holidays. But the certification committee of the Dutch Medical Association, which has a role similar to the UK's General Medical Council, insists the case is not about age but about meeting the quality requirements for recertification.

All GPs, of whatever age, must apply for recertification every five years to ensure they maintain the quality of care and take part in continuing medical education. One of those requirements is participating in mutual deputising, or locum, services. This, argues the Dutch society of general practitioners, ensures they gain sufficient experience of emergency care, especially with patients they are unfamiliar with.

However this has become a problem for Dr Bakhoven, one of an estimated 190 working GPs in the Netherlands aged over 65. Dr Bakhoven, who qualified in 1958 and has run her current practice for 20 years, believes the system of deputising services is wrong. “I come from a generation where a doctor had their own practice and always worked every night and weekend. I still do that. When something serious happens I want to be involved.” She considers that the greater free time expected by younger doctors and the idea of deputising is her profession's downfall.

Since her five year certification became due for renewal two years ago the Medical Association has granted her annual certification to allow her time to meet its requirements. Dr Bakhoven has attempted to join the deputising services but, she admits, is slow at using its computer system.

Dr Bakhoven's certification has now been withdrawn. She has mounted a legal challenge and the case has been appealed by the general practitioners' association to the Council of State.

Dr Lourens Kooij, secretary of the medical association's certification committee, said Dr Bakhoven's activities “do not satisfy the requirements for recertification in that she does not do any deputising services with other GPs . . . that is a demand in the Netherlands.”

He added: “This has nothing to do with age; age discrimination is not allowed. Last year we renewed the certification of a GP who is 83 and who met all the requirements.”

A spokesman for the Council said that the decision before it is: “Can the GP carry on her work . . . if she does not satisfy the demand for participating in the deputising services?”

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