All-night service for one-off cases

Press, 21 November 1987, Page 23

All-night service for one-off cases

By

JANE DUNBAR

In Bealey Avenue, there is a house where the lights stay on all night. Large white letters stretch out across its roof. The letters read “After Hours Surgery.” About 800 patients a week pass through the doors in search of comfort and cures. Open from 5 p.m. to 8 a.m. daily, and 24 hours week-ends and public holidays, the centre is run by receptionists, nurses and a co-operative of 148 doctors who work on a roster system. The centre opened in July with the aim of providing better working conditions for general practitioners and "a first class afterhours service” for the public. Dr lan Robertson, one of the scheme’s main promoters, says it is "possible and should be practical for Christchurch G.P.’s to work reasonable hours and have time off.” The service prevents doctors

' being called out at all times of '•the night all week, and patients ' from having to go through a long series of calls to reach a duty doctor. The centre offers cork plete service, from consultations

to house calls, he says. To check out how things were going, a photographer and I recently decided to spend a Friday night at the centre from 7 -p.m. to 7 a.m., to talk with ’ patients coming through and the doctors who were working. It was a quiet night, but otherwise fairly typical of most: mums • and dads with kids with sore tummies or earache, couples "here for personal reasons,” asthmatics and a few people with minor injuries. The grisly stuff was evidently being dealt with at Accident and Emergency. During the quiet times some of . the doctors sat upstairs drinking " coffee and talking. This opportunity for meeting other G.P.s and discussing ideas and problems is something she particularly likes about working ’ at the centre, says Dr Rosie

Chambers, a G.P. registrar. It is also great for week-end work: "You do your eight-hour shift, and then that’s that.” The roster system certainly has changed things dramatically for the co-operative’s doctors. Dr James Keithley, for example, said he had on average been on call 65 hours every week-end for the last 15 years. Now he has to work only the occasional eight-hour rostered session, about once a month. House calls have also become

easier, and safer, since doctors ho longer go out alone. Instead, they go with a “safety conscious” driver in the centre’s own car, or by taxi, and if there is any trouble, the driver can use the radio telephone to call for help.

The set-up, then, is good for the G.P.s — better working hours, a chance to socialise with other doctors and increased security. But what of the patients? The size of the co-operative lays it open to criticism of being

too big and impersonal, "like a supermarket.” This is one of the major arguments of some doctors who have not joined the co-operative. When the centre opened, there were 120 co-operative members, now there are 148, and it has been suggested that all Christchurch doctors will eventually join.

Dr Mike Foster, of the Christchurch South Health Centre, doubts, however, that he and his six partners will join: “We’re quite happy with what we’ve got here.”

They, and three doctors from Waltham, pool resources for an after-hours service so that each doctor is only on call once a fortnight, “which is very reasonable,” says Dr Foster. Staying as they are, they can also provide a cheaper, more personalised and quicker service than the larger centre, he says. “Most of our patients have met us or know us, and we have immediate access to their files — which have to be good, and are the absolute basis of good medical practice.” At the Bealey Avenue centre, permanent records are not kept. It would be impractical because of the transient nature of its patients. A record of consultations is given to the patients, however, and copies sent to their doctors.

“We’re really just a babysitting service,” says Dr Robertson.

He stresses that the centre is offering an after-hours service, without any conflict of interests with ordinary hours general practices.

The service is for one-off cases, and patients are not encouraged to become regulars. This does not mean, however, that people are treated with any less care. Since the G.P.s are working fewer hours on call, they are more likely to be relaxed and approachable than when constantly on call. Certainly the attitude to patients seems different, with Dr Robertson suggesting a prize should have perhaps been given to the 1000th patient who passed through the doors. Joking or not, this was a reflection of a new way of thinking, with commercial undertones but also with what seems to be a base of genuine goodwill. Doctors who feel better about their work are no doubt more welcoming to their patients.

Another plus for patients is that there is no reason to feel hesitant or guilty about calling a doctor in the middle bf the night. The centre has three doctors on call during the late shift. Although two may sleep at home on quiet nights, there is always a doctor awake and at work at the centre. Home visits are not a problem — they can even be a welcome way of staying awake — and a doctor can move from one call to another by messages being relayed by radio telephone.

Of course home visits can seem expensive. A pensioner who called a doctor out at 5 a.m. paid a bill of $55: of that, $22 was for the taxi, so the doctor’s fee (for 20 minutes consultation and 20 minutes travelling) and

the centre’s overheads were being covered by $33. To call someone out in the middle of the night to fix a broken window costs a minimum of $lB4, just for the labour. The centre has made a point of only paying its doctors ordinary rates to avoid accusations of “greedy doctors,” and the house calls run at a loss as they cannot average at more than two an hour. “This is a service to patients first and a business second,” says Dr Robertson. Certainly the patients we spoke to during the Friday night all seemed pleased with the centre. “It’s fantastic here,” says the mother of one young woman who has “been sick all her life.”

“It’s good to have somewhere you know there’s a doctor and you don’t have to wait very long. “Before, we’d have to go all over Christchurch to find a duty doctor, and if we went to Public (hospital), we’d have to wait three or four hours.”

Paying a fee compared to waiting for hours at the hospital was well worth it to her. In any case, she is covered by medical insurance.

Fees vary: $2O for a consultation for children, $33 for adults, with $3 off for pensioners. Each of these is $5 less if it is a brief consultation, and $lO less if it is a follow-up consultation on the same day or week-end. Home visits cost $2O for children, $32 for pensioners and $35 for adults. G.S.T. of $3.36 is added to consultations, and $3.64 to home visits. The centre now has three consulting rooms and one treatment room. By June of next year, a new building should have gone up which will eventually hold seven consulting rooms, and

two treatment rooms. The new Urgent Pharmacy will also be on the site. On November 9, the doctors’ co-operative, Christchurch Emergency Medical Services, Ltd, held its first . annual general

meeting. A few minor difficulties were discussed, but there were no major problems, says Dr Robertson. More than anything, he says, “we wondered why we didn't do it 10 years ago.”

No conflict with general practices