The newspapers are full of stories about out of hours emergency care in medicine. The renegotiation of the GP contract by the British Medical Association secured a position whereby GPs do not have to provide emergency cover between the hours of 6.30pm and 8am. The responsibility for providing such care rests with Primary Care Trusts.
If politicians reflect public opinion then there has been a noticeable backlash after an overseas doctor came to Britain to carry out some duties for a company set up to provide services to cover the out of hours emergency service. A patient died from a fatal overdose of diamorphine. The newspapers were quick to comment.
‘Inherent weaknesses’ in the vetting procedures meant that the doctor was allowed to treat patients despite the fact he had failed an English language test and had no experience of the NHS, an inquest found.
On Feb 16, 2008, working his first out-of-hours shift and ‘tired out’ after only arriving in the country the day before, a 70-year-old patient was given up to 20 times the recommended amount of diamorphine to treat pain in his kidneys.
People have called for his arrest and prosecution. We can lock an errant medical practitioner away and introduce a few more rules about vetting and testing for English. The doctor in this case was tested and failed but the system allowed him to be employed elsewhere. By convicting him he becomes the scapegoat for the system that seems incapable of criticizing itself.
In this way we can all go back and get on with life until the next tragedy occurs when the investigations start again. What we need to recognise is that this didn’t occur because of one incompetent individual, it occurred because the system allowed it to happen.
There is a more fundamental question however as to what the public expect in terms of emergency care. There is a strong argument to suggest that the public see it as an ethical obligation of doctors to provide care outside normal hours. Many politicians now see the medical profession as disenfranchised from a social responsibility to provide care out of hours. This is not good for anyone as it is core to the trust the public places in a privileged group. If such trust is lost, it will not be easily regained.
There are many parallels with emergency care in dentistry from which the profession can learn. There is a public expectation that emergency care should be provided although there is also a view that dentists are not required 24 hours a day, unlike medicine. What is clear is that there is an increasing expectation amongst the public that health care is not a 9.30am to 5.30pm job. What does the profession think?