Mary Dejevsky: Note to GPs: some jobs have to be 24/7

Friday 15 January 2010 01:00

All right, deep down many of us are simply jealous. GPs cannily won themselves a massive pay rise for meeting the relatively modest targets they had set themselves, and then decided, not unreasonably, to improve their work-life balance. The result was many more GPs putting in many fewer hours and the almost universal abandonment of working at nights and weekends.

Which is how, as an inquest is currently hearing, Dr Daniel Ubani and other foreign doctors came to earn what were by any standards fabulous sums, flying in from other EU countries to work the hours British GPs had spurned. Looking on the bright side, you might regard it as almost miraculous that so few of these stints have ended as tragically as Dr Ubani's first shift, when he managed to kill two of his patients. No doubt all the regulators and agencies lurking in and around the NHS would say this vindicates the safeguards that are in place.

But this really isn't, or shouldn't be, the point. Forget the money for a moment, and ask instead how GPs – expensively trained still mostly at taxpayers' expense – are claiming the regular working hours of junior clerical staff, and leaving mostly inexperienced or overseas doctors to fill the gap.

All professions dislike being regulated by outsiders; and doctors regard themselves, unapologetically, as being at the very least near the top of the professional tree. Part of being a professional, though, is to care about your work and to take personal responsibility for maintaining standards. I wonder whether those who effectively clock on at 9am and off at 5pm really deserve the status the rest of us reserve for committed professionals.

There are jobs – and medicine is surely one of them – which cannot be treated as 9-5. (Much journalism, by the way, is another.) I'm not asking doctors to work 24 hours seven days a week – though once upon a time some, including uncles of mine, almost did. But neither can they expect to work office hours. People fall ill at all hours, and on bank holidays. Why are GPs not contractually required to work shifts, ensuring care around the clock?

Dr Ubani's case may be unusual, but it is not unique. Almost five years ago, The Independent published the harrowing account of Angus MacKinnon, whose partner, Penny Campbell, died of septicaemia after being seen by a succession of out-of-hours GPs over Easter. None came close to a correct diagnosis, or even appreciated how ill she was.

It is surely no coincidence that as GPs have fled out-of-hours working, more and more people have resorted to A&E departments. If the NHS wants to improve A&E, it should start by demanding more of GPs.

Sorry, but in the police, little is not as good as large

As someone who stands only marginally over 5ft in her stockinged feet, I feel a certain obligation to raise a cheer for PC Robin Port, who has just joined the Devon and Cornwall force in Tiverton. PC Port, who is 29 and already dubbed the pint-sized PC – that's the sort of condescending shorthand we miniatures learn to live with – is 5ft exactly, which makes him a full 8ins short of what used to be the minimum height requirement for the force.

The trouble is that I can't quite bring myself to think that Port's achievement, made possible by anti-discrimination legislation, is quite such a good thing. I have noted in recent years not only that policemen (and women) seem to be getting younger – we all know why that is – but that they seem to be getting shorter as well. As a former soldier who saw active service and trained in martial arts, Port says he is confident he can hold his own, and I'm sure he can. What these smaller police lack, though, is the ability to impose themselves on a situation simply by their presence.

Your average thug respects few things, but I have no doubt that size is one of them, and Port's martial arts credentials will not be emblazoned on his policeman's helmet. You can argue, if you will, that "modern" policing should not be about imposing authority. But I doubt that I'm alone in sometimes wishing that it were.

Enjoy your food – just not on the run

At a packed think-tank meeting, with more than a sprinkling of the great and good, I was astonished when my late-arriving neighbour took a chocolate bar from her bag, unwrapped it and made to eat. I was so astonished, in fact, that I actually expressed my disapproval, suggesting that this was not an appropriate thing to do.

Cross at my whispered intervention, she said she had had no time to eat and asked whether I wanted her to faint. She later pointed out that someone on the other side of the hall was eating a sandwich; would I upbraid him, too? To which my (silent) response was: certainly, had I been sitting beside him.

In the United States, middle-of- the-day meetings tend to be either formal – no food/drink allowed – or the "brown-bag", where you are positively invited to take a sandwich. We could do the same. Or perhaps this, and similar esteemed establishments, should simply lease some space to Starbucks and treat it as an extra revenue stream?

More and more, it seems, people regard quite formal events and in-between times (public transport is a glaring example) as feeding opportunities. One of the seats in the Tube train I was on yesterday lunchtime was taken by a well-dressed young man carrying a small briefcase and a small package. He placed the briefcase tidily on his knees, positioned a small box of sushi in the centre, removed the lid, and got to work with the chopsticks. This was public transport dining at its most refined. But I still wish he hadn't.

In much of the US, eating (as well as drinking) is banned on urban public transport. In France, eating, even on a small scale, is treated as an occasion in itself. Following either example, or both, would be a vast improvement on the mass public chomping that is fast becoming the UK norm.

* As the controversy raged over liability for injuries a pedestrian might sustain from slipping on a cleared bit of icy pavement, I was intrigued to come across a Westminster council worker purposefully clearing a lethal stretch of walkway with a rather natty piece of kit. It turns out to be called a wheeled snow-blade and the 50 deployed in Westminster come in a cheerful shade of orange. Low-tech, but neat and effective, it takes some of the sweat out of ice-clearing. Bravo whoever invented this.

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