"I think it would be a good idea in view of some public discontent with the present out of hours services to explain why I for one am very relieved to be working for Shropdoc.

When I first came to the area I was in a practice with another GP and we shared the out of hours work, which meant alternate nights and alternate week-ends.

This went on for many years, and in those days we had no mobile phones, so arrangements had to be made with others or our partners to "hold the phone" while we were on calls.

The reason was not necessarily workload as such, but not knowing from minute to minute if I would be faced with a life and death situation, at any hour of the day or night.

It was the relentlessness of this problem over nearly 25 years that wore me down, made me irritable, and potentially leads to burn- out of compassion: sometimes I felt in a worse state than the patients before me.

At times we shared a rota with a local doctor in Presteigne, but things were always difficult around holiday times, when one of us took a break leaving the other two to do the work.

When we finally did join up with all the other local GPs in a "consortium" there were about 10 of us, which was a great relief only having to work once every week or so.

This came too late for some of us who through the stress of the previous situation had decided to leave local practices, or so impinged upon family life that marriages had suffered.

We settled into this approx 1:10 rota for a couple of years, when the new GP contract brought up new stringent adminitrative and audit directives, that even the 10 of us could not manage to cope with, including verifiable timings for telephone calls and attendances on visits, and what is now computerised records of calls, times and events of visits and more.

To cap it all the Government costed all this work as worth about £6000 per practice of 4-5,000 patients, ie about £2000 before tax per GP, which we regarded as being an insult.

On offer was what is now Shropdoc, which means that local GPs such as myself can be on call 2-3 times per month for 6hrs or so, with a driver and all the admin done for us, and earn much more in a year than had been offered for all the out of hours work.

We gratefully accepted the new system. My own general health has dramatically improved because of the new system.

In rural Powys practices that were having difficulty recruiting new partners, the availability of out of hours cover dramatically improved the recruitment of young GPs.

There was something to be said for the continuing 24hr care of old, but it left little time for anything else but work, and was not truly benefitting the day-time services of the GPs patients.

Because we were self-employed there was no one 'looking after our mental health', only authorities with the power to dismiss us if we stumbled.

This situation is considerably improved today, even though it feels as if we have to jump through more and more hoops to stay in the same place. Certainly There is more ticking of boxes than a need to get to know patients better.

I know of no-one who would wish to go back to those days again. "

Article written by Kevin Howcroft