After-hours services

Fewer doctors provide direct after-hours medical services. Instead, many after-hours medical services are provided by after-hours medical deputising services, co-operatives of local doctors, or by a colleague/s on a roster basis or by hospital emergency departments. For general practices and since July 2013, Medicare Locals are now responsible for the coordination of after-hours medical services within their local areas.

This change in after-hours service arrangements has led to a modification in the requirements of general practices around their obligation to accreditation standards.In response to this, the RACGP is adopting a position in relation to Criterion 1.1.4 of the RACGP 4th Edition Standards as follows:

• Practices are required to demonstrate that they are aware of the arrangements in place for their patients to access after-hours care; and
• Practices are required to have processes in place to alert their patients to these arrangements.

1. Have a clear process for providing after-hours medical services to your patients.  
2. Communicate this process to staff and patients. For example, this can be through a practice newsletter, on your website, or on your practice telephone answering service. 
3. Know the contact details of the after-hours service used at your practice and be able to communicate this to staff and patients, if required.     

Deputising services should keep detailed clinical records and promptly advise the regular doctor/practice as to any services provided to their patients, and particularly if any follow-up is required. Most deputising services will provide a clinical report via secure electronic delivery and/or facsimile to your practice within 24 hours of a visit to any of your patients.    

Further, at times, seriously abnormal pathology or other test results might only be available after hours and in such instances the pathologist/other should be able to contact the referring doctor (or the manager if they are unable to be contacted), either through your deputising service (who would hold your phone number) or directly by the pathology/other provider – which means providing your contact phone number to such services as well as to the deputising service.

The after-hours service you provide will have a lasting impression on all your patients. Your practice may secure good or poor recommendations based on your after-hours care provision.

For specialist practices, each practice will have a different approach to how they manage patient’s need for after-hours care. It is important that the practice has a message on the phone regarding after-hours calls. Some practices may have specific arrangements with their referrers and patients regarding the provision of these services. For example, post-op patients may be given a direct contact number.

For particular types of practices (surgical, obstetrics, etc) it is standard practice to be available after hours to patients you have undertaken a procedure on – either to be available yourself or have a nominated colleague available who has received appropriate handover of information regarding the patients and their procedure. Colleagues who cover practitioners should always comply with their usual standard of practice and be familiar with the procedures for which they are covering. It is important for doctors to remain within their scope of practice.

There may be some instances where a GP needs to be available after hours and the practice manager should have contact details for all doctors in their practice.

Ensuring your doctors have regular annual leave is important for their health.

Surgeons should schedule their procedures to be completed 7 to 10 days before annual leave to ensure they are available in the immediate post-operative period. In the event that you go on leave after operating, ensure that you have adequately handed over your patients to a colleague or locum.

As a practice manager, you also need to have regular annual leave as it is important for your health.