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The Duty Doctor: a cautionary tale of function creep in GP land

By Dr. Colin Coulthard |

function creep. noun. 1. the gradual widening of the use of a technology or system beyond the purpose for which it was originally intended, esp when this leads to potential invasion of privacy.

This is a phenomenon that we are all too familiar with in GP land. Something starts out as one thing and then gradually mutates into another. Services are commissioned, and then gradually over time the funding reduces, and we find that we’re expected to continue to provide them as it’s now just part of our job.

However, the concept of the “duty doctor” in a GP practice is an excellent cautionary tale of how an ad hoc modification to a complex system can lead to unintended adverse consequences. If you want to find out more then read on…

A decade ago, demand was a big problem but not nearly the disaster that it is these days. GPs were being interrupted during their day to day work. This was a problem as it lead to errors being made.

A few surgeries introduced the concept of the “duty doctor”. This was a designated doctor who reception could go to if they had any queries, and who would make sure that they were available on the phone whilst the surgery doors were open, in case something arose that the other staff couldn’t deal with.

However over time this has gradually mutated. As the “duty doctor” was an ad hoc solution, no systems were put in place to limit their workload. Because it becomes easier for people to “just ask the doctor” they do, more and more. This creates a system where our staff become de-skilled. More so because each different “duty doctor” deals with problems in a different way and so they don’t know what to do from one day to another. The “safe” option is always given that if they’re unsure then they should ask the “duty doctor”.

After a while, because the duty doctor is now so busy, their timetable is changed. They’ll now have a reduced number of booked appointments so that they can deal with all their duty work. This gives them more flexibility. Now they can deal with even more problems. If someone walks in, they can be seen after a brief wait, because the duty doctor now has time. A visit can be done almost immediately because the duty doctor has the resources. In the meantime, pre-bookable appointments have reduced, and so demand has gone up even more.

Soon patients become aware of this new service, and start turning up, or phoning and demanding to speak to the doctor. In turn, the duty doctor now has no pre-booked appointments, and even their colleagues are now keeping slots open for “extras”. Demand goes up even further.

And so workload gets worse. Because of this the doctors make mistakes and are unhappy. This decreases patient satisfaction. The vicious cycle continues...

All this follows from the superficially sensible decision to appoint someone as the “duty doctor.” I refer you to law one of systems thinking -