Recently I moved back to Wales after spending nearly eight years away. I have been working mainly in accident and emergency (A&E), and have completed the first part of my FACEM(Aus). I am unlikely now to return to Australia, however, as I have two young children; the youngest is six months. I am struggling with which path to take because getting an SpR in A&E would mean doing most of the training again, as well as more exams. I have been interested in general practice for some time and am thinking of applying for the VTS in early 2007. I still have some time to complete before being able to do my GP registrar year, such as paediatrics, psychiatry, etc. My biggest concern is having to leave the kids to do an SHO job, with all the out of hours and long days, when it is nearly eight years since I was an SHO. Apart from getting a staff grade job in A&E, which I think I would find frustrating seeing that I was midway through my training in Australia, do you have any advice for me?

Abstract Background Most of the patients with gastroenteritis seeking health care services are managed in primary care; yet, little is known about these consultations. Syndromic-based surveillance of gastrointestinal infections is used in several countries, including Norway. Aim To investigate the extent of, and explore characteristics associated with, consultations for gastroenteritis in primary care and to compare consultations in daytime general practice and out-of-hours (OOH) services in Norway. Design and Setting Registry-based study using reimbursement claims data from all consultations in general practice and OOH services in Norway over the 10-year period, 2006–15. Methods The main outcome variable was whether the consultation took place in general practice or OOH services. Possible associations with patient age and sex, time and use of point-of-care C-reactive protein (CRP) testing and sickness certificate issuing were investigated. Results Gastroenteritis consultations (n = 1 281 048) represented 0.9% of all consultations in primary care (n = 140 199 637), of which 84.4% were conducted in general practice and 15.6% in OOH services. Young children and young adults dominated among the patients. Point-of-care CRP testing was used in 36.1% of the consultations. Sickness certificates were issued in 43.6% of consultations with patients in working age. Age-specific time variations in consultation frequencies peaking in winter months were observed. Conclusions The proportion of gastroenteritis consultations was higher in the OOH services when compared with daytime general practice. Young children and young adults dominated among the patients. The seasonal variation in consultation frequency is similar to that shown for gastroenteritis caused by norovirus.

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Prioritization and management of calls from older people to GP out-of-hours services

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab021 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Suzanne Smith ◽

Lucia Carragher

Keyword(s):

Older People ◽

Service Provision ◽

Emergency Services ◽

Oldest Old ◽

Community Dwelling ◽

Third Party ◽

Older Person ◽

Out Of Hours ◽

Accident And Emergency ◽

Community Dwelling Older People

Abstract Background Urgent out-of-hours medical care is necessary to ensure people can remain living at home into older age. However, older people experience multiple barriers to using out-of-hours services including poor awareness about the general practitioner (GP) out-of-hours (GPOOH) service and how to access it. In particular, older people are reluctant users of GPOOH services because they expect either their symptoms will not be taken seriously or they will simply be referred to hospital accident and emergency services. The aim of this study was to examine if this expectation was borne out in the manner of GPOOH service provision. Objective The objective was to establish the urgency categorization and management of calls to GPOOH , for community dwelling older people in Ireland. Methods An 8-week sample of 770 calls, for people over 65 years, to a GPOOH service in Ireland, was analysed using Excel and Nvivo software. Results Urgency categorization of older people shows 40% of calls categorized as urgent. Recognition of the severity of symptoms, prompting calls to the GPOOH service, is also reflected in a quarter of callers receiving a home visit by the GP and referral of a third of calls to emergency services. The findings also show widespread reliance on another person to negotiate the GPOOH system, with a third party making 70% of calls on behalf of the older person seeking care. Conclusion Older people are in urgent need of medical services when they contact GPOOH service, which plays an effective and patient-centred gatekeeping role, particularly directing the oldest old to the appropriate level of care outside GP office hours. The promotion of GPOOH services should be enhanced to ensure older people understand their role in supporting community living.

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