Rural GPs cutting their hours

By Peter Gould
BBC News Online

Dr Alun Jones-Evans takes morning surgery

In a recent survey of family doctors, many said one of their priorities was to reduce the number of hours they work.

Long working days tend to be associated with junior doctors working in hospitals. But the life of a GP often involves working anti-social hours.

Dr Alun Jones-Evans has spent the past three years as a partner at a practice in Llanfair Caereinion, near Welshpool in Mid Wales.

Until recently, he could expect to find himself working outside surgery hours on a regular basis, sometimes right through the night.

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"We could be quite busy," he says.

"We would deal with all the calls ourselves, and we did not have a good infrastructure behind us."

On call

I am a firm believer in the NHS Alun Jones-Evans Family doctor

Last year the practice joined a doctors' co-operative. Several neighbouring practices now run a joint service to provide cover outside normal hours.

The new system means Alun works fewer unsocial hours. When he is on call, he has at his disposal a car kitted out with medical equipment, together with a driver.

The calls are prioritised at a control centre, allowing him to concentrate on treating the patients.

Susan Hill, the practice manager at Llanfair Caereinion, says the system benefits everyone.

"It makes for a much less stressful life for the doctors," she says.

"It means they are not coming in the next day trying to do a full day's work having been up all night, racing around the county.

"The patients get a better service, but we have had to educate them into trusting that this is the best way of getting them the care they need."

Time off

The practice has almost five thousand patients on its books, spread out across 440 square miles of Powys, "much of it vertical", according to Susan Hill.

The geography can make it difficult for patients to get to the surgery and equally time-consuming for doctors to make house calls.

Alun Jones-Evans is one of many GPs across the country trying to spend more time at home with his family. He is employed as a "three-quarter time" doctor, which means he usually gets an extra day off.

"I am fortunate as I have some time off in the week," he says.

"I find that the working day here, whatever rota you are on, is a busy day and the out-of-hours work in the evenings and at weekends certainly takes its toll."

The practice has just taken on a new partner. Dr Eleri Gittins was born and brought up in the area, and has been a patient at the surgery for many years.

She is married to a local farmer, and has a two-year-old son, Rhys. She speaks Welsh, an advantage in an area where a quarter of her patients regard English as their second language.

Family life

The practice knows it was lucky to find her. In many rural areas, it is proving increasingly difficult to find replacements when doctors reach retirement age.

Many young doctors do not see their careers in general practice. But having been a hospital doctor, Eleri thinks that becoming a GP will be much more compatible with family life.

"I am looking forward to the job a lot," she says.

"I will be working where I was brought up, and being near to my family and friends, and hopefully having a more normal life than I had when I was working in hospitals."

When she recalls one week when she worked 102 hours, you can see her point.

"It was one of the reasons for becoming a GP," she says.

"I think it is my best chance of having a normal family life."

Lifestyle

Having faced the problem of recruiting a new doctor, Susan Hill believes that GPs need to be well rewarded if they are being asked to buy into a rural partnership.

But looking out at the hills around the surgery, it is not difficult to see the attractions of the rural lifestyle.

"It is very much a question of choice," she says.

"If you are the sort of person who wants to live in God's own country where the views out of the window are not smoky chimneys and traffic queues, then it is the perfect place to live."

Alun Jones-Evans, for one, needs no convincing about the attractions of the life of a country GP.

"It is very satisfying," he says.

"I obviously made the decision to work in a rural practice having done my training in Cardiff. Both my wife and I felt we would like to live and work in a rural environment, and I enjoy working here.

"I am a firm believer in the NHS and the values it started with. I see from day to day the terrible state of some aspects of the NHS.

"Some things which particularly spring to mind are long waiting lists, people waiting for orthopaedic operations, for example. That is a constant worry for us and for the patients.

"We just have to do the best we can for our patients and try to control their symptoms while they are waiting."