Out of hours work in general practice.

SIR,-Drs Steve Iliffe and Ursula Haug suggest that general practitioners should be aware of their tendency to omnipotent thinking and behaviour.' I have analysed the need for consultations that I have carried out at different times. Of 388 out of hours calls that I made in the past three years (1 July 1988 to 30 June 1991), I considered 194 to be essential and 194 of questionable importance or unnecessary. Of 241 home visits that I made during the day during the past quarter (1 April to 30 June 1991), I considered 216 to be essential and 25 questionable or unnecessary. Of 390 consultations at my surgery during June this year, 363 were essential and only 27 questionable or unnecessary. This shows that out of hours calls are often a source of particular irritation to me and probably detract from my performance the next day. I am not sufficiently omnipotent to perform such visits with equanimity. Nevertheless, I believe that patients should have access to a general practitioner from their area out of hours. The present restriction on paying higher rate night visit fees only to doctors working in rotas of 10 or fewer principals is arbitary, and I can see no reason why it could not be extended to rotas of 30-40 principals. One general practitioner would normally be able to cover the 50000 to 100000 patients concerned during a night, but this task would occur sufficiently seldom for it not to impose excessively on within hours work.