Why David’s Gray death was predictable

A lot has been written recently about the 2004 contract that allowed GPs to opt out of  providing care to their patients at night or on the weekend. And about the fact that GPs are now paid more for doing less than ever before. I’m old enough to remember doing nights and weekends on-call and visiting elderly patients on a regular basis in their own homes with the aim of keeping them well.  And then I had a few children, and worked part-time for a while, and then the new contract came in, and GPs no longer did their own on-call, and the requirement to provide enough appointments in surgery, along with the obligation to ensure that every action and thought was entered on the computer meant there was less and less time to do other things. Things like visiting elderly people who weren’t ill as a means of keeping them well and providing them with the human contact we all need to thrive.

I can’t think there can be any UK doctor worthy of the title who isn’t sickened by what happened to David Gray. But I also doubt there are many who couldn’t have predicted that flying in doctors from outside an area, let alone another country, let alone from another specialty, wouldn’t inevitably, one day, lead to a tragedy like this. After all, any GP could tell you that even the most experienced GP needs all her wits about her to deal with that late night call, the phone consultation with a patient you don’t know, or the anxiety filled home visit when people are in pain, frightened or confused.

The bottom line is that no UK GP has been happy with the idea of drop in a doc, whereby any doc will do so long as someone, somewhere in the EU, has given them that title. The idea that any unit of doctor will do is peculiarly beloved of this government and stems, I believe, from a complete disdain for the concept of professionalism. Sadly, for this government, and for patients, doctors are viewed as interchangeable factory workers, who, much to the irritation of their political masters, think rather too highly of what they can do for patients using their own initiative and creativity.  So, for the government, devising an out of hours system back in 2004, it made sense to reject the doctor’s idea that more GPs be employed so that they could carry on providing both day and night cover and instead they decided to introduce drop a doc, any doc.

In many areas of the country, like my own in North London, the local GPs weren’t convinced of the wisdom of this strategy and so the service is run predominantly by local GPs, and everyone who contributes to out of hours care is adequately trained for the task and given proper support and back up. But not everywhere it seems. By no means everywhere.

So whose duty of care is it to make sure others don’t suffer the fate of David Gray? Well firstly it’s every patient’s doctor’s duty to take care that her actions or inactions do not harm their patients, to ensure that they either provide good out of hours care themselves or to ensure that the out of hours care provided is of a sufficiently high standard.  And it’s every Primary Care Trust’s duty to make sure they have the systems and personal in place to do the same. And I think it is surely every government’s duty of care to make sure they use common sense as well as tried and tested systems and procedures to ensure that when it comes to that most hazardous time to provide care- when the staff numbers are low and tiredness inevitably creeps in-  that the highest professional standards not the lowest common denominator prevail.


    I, too, worked in the ‘good old days’ when we did our own out of hours and I agree with most of what you say. Yes we need more GPs so that people can do OOH overnight and not have to work in the morning. However, you fail to highlight the elephant in the room. The reason why so many PCTs resort to drop in doctors is the lack of young GPs who will do any OOH. Yes, some of us got the work life balance wrong but the modern doctors have got their balance wrong as well in an opposite direction. What the hell did you join medicine for? Did you think it was a simple matter of doing the set hours and then going home? OOH is in a crisis because the last generation (like me) have gradually withdrawn from shifts in the forlorn hope that the younger GPs would take over.
    A better question would be to ask why medical schools have created a cadre of doctors who refuse to do any more work than they have to.
    By the way, you made an excellent point at the start. Because we now have a system where visits to the elderly or nursing homes are only done acutely we are missing the chance to prevent illness and hopsital admissions. If GP looked at nursing homes a lá wards and had regular ward rounds, it would be interesting to see what problems could be avoided.