Industries

Continuity: who answers when the practice is closed

A practice closes at six. The people who need it do not stop at six.

Published on 15 June 2026 — Algeria Agency

The article beside this one describes a permitted surface much narrower than the visible one: what a health professional may not say, promise or publish.

This article is about a different boundary: the hours when nobody is there. It is wider than people think — a practice open forty hours is closed for a hundred and twenty-eight.

During those hours, people call. Some want an appointment, a few need something else, and all of them form an opinion of the practice from what they meet: a ringing tone, a message, or nothing.

We describe what has to exist during that absence and we refuse several things along the way. Nothing in this article says how to assess a patient; section 8 says precisely the opposite.

The practice closes, the patient does not

Forty hours of opening a week leaves a hundred and twenty-eight with nobody there. That is a ratio of one to three, and it does not match how a practice thinks about its organisation.

Most of a practice’s management arrangements concern open hours: the queue, the waiting room, the schedule, the allocation of slots. Closed hours are treated as a void rather than as a state.

They are not a void. Things happen in them — calls, messages, people travelling to a closed door, people looking for information and finding something out of date.

The difference between a practice that has organised that period and one that has not is not a question of means. It comes down to a handful of written decisions, the most important of which is a message recorded once.

What this article calls continuity is that: what exists and works when nobody is there. It is not an additional service, it is your practice’s default state three quarters of the time.

What continuity is, and what it is not

Continuity, in the sense used here, is a signposting arrangement. It says where to go, who to contact, and when the practice reopens.

It is not out-of-hours medical cover and must never be presented as such. Continuity of care is organised by the structures provided for it, and a practice that let people believe it was on call when it is not creates exactly the danger it claims to cover.

Nor is it a remote advice service. What the person answering does is say what is open and what is not; they ask no question about symptoms and draw no conclusion from any.

That restriction is what makes the arrangement workable. Signposting can be held by a secretariat, a recorded message or a colleague on call. Advice cannot, and an arrangement that drifts towards advice always ends up held by somebody with neither the competence nor the standing for it.

The distinction has to appear explicitly on every surface. A message saying "in an emergency, call the emergency number" and one saying "leave your problem after the tone" do not build the same thing, and the second is a promise nobody will keep at three in the morning.

The out-of-hours message is the most heard thing you have

An out-of-hours message is heard by more people than any page, and it is recorded in thirty seconds by somebody in a hurry, once, four years ago.

It should contain four things and it generally contains one. The exact hours, the reopening date when the closure is temporary, where to go in an emergency, and how to get an appointment.

The second is the most often missing and the most sought after. "We are closed" does not say what the person wants to know; "we reopen on Monday the 8th at eight" answers the question they are actually asking.

The third must point to a public arrangement and not to a personal number. That is a safety rule as much as an organisational one: a personal number is not permanently reachable, and signposting that fails is worse than none.

The message is re-recorded at every change of hours and every closure, and that is the only maintenance it needs. A message announcing a reopening that passed three weeks ago teaches a patient that nothing in this practice is current.

The three destinations, and which comes first

Somebody calling a closed practice is looking for one of three things, and the order in which they are handled decides the quality of the arrangement.

The first and rarest is a situation that cannot wait. It must be addressed first, in one sentence, before any other information: where to call or go immediately. Somebody in that situation does not listen to thirty seconds of opening hours.

The second is a need for care that can wait but not until reopening — and the answer is the on-call arrangement or the nearest open facility, named explicitly rather than hinted at.

The third is by far the most frequent: making or moving an appointment. It accounts for most of the volume and it needs nobody, provided a way of doing it exists without speaking to a person.

That is where the arrangement pays for itself. A practice offering a way to request an appointment outside hours recovers a list in the morning rather than a telephone queue, and it frees the line for the first two categories during open hours.

What the person answering may say

If somebody does answer outside hours — a secretariat, an outsourced service, a member of the team — the scope of what they may say has to be written before they answer once.

What they may say is short: the hours, the reopening date, the existence of an appointment and its time, the address, and signposting to emergency services or the on-call facility. It is a closed list.

What they may not do matters more and should be phrased positively rather than as a vague prohibition. They ask no question about symptoms, do not note them, do not pass them on, and never say whether something is serious or not.

The last is the hardest to hold humanly, because an anxious person asks the question directly and the urge to reassure is natural. "I cannot answer that, and here is who can, now" is the sentence to be learned, exactly.

An outsourced service adds a further requirement: what it records, where that goes, and who can reach it. A supplier who records calls and keeps messages holds health information, and that is settled in writing before the first call rather than after an incident.

The locum: what has to be ready before they start

A locum is continuity of another kind: somebody practising in your place, in your rooms, with your patients. The professional conditions of that arrangement are a matter for your professional body and the regulation, and this article does not touch them.

What it does touch is the organisation around it, and that is regularly improvised on the first morning. Three things have to be ready before the first person walks in.

The first is access to what the locum needs in order to work, and no more. Full access to an entire patient record because it was simpler to configure is a decision taken by default and it should not be.

The second is the list of things not to be decided during the absence: what waits for your return, what is redirected, and who to call with a question. Written down, it saves the locum from having to guess at your practice.

The third is what patients are told. A patient who discovers on arrival that this is not their usual practitioner is entitled to know beforehand, and saying so when the appointment is made is an elementary courtesy that prevents half the complaints.

Holidays, feasts, and the month everybody closes

Long closures are predictable to the week and are announced on average three days beforehand. It is the easiest gap to correct in this whole article.

A closure is announced four to six weeks ahead, on the surfaces patients consult: the business listing, the out-of-hours message, and a note on the door. All three, because people do not use the same one.

The listing is the one that gets forgotten and the one people look at. A listing showing normal hours during a fortnight’s closure physically sends patients to a locked door, which is the only completely avoidable harm in this section.

Periods when everything closes at once need particular attention, because the usual signposting stops working: the colleague you point to is closed too. Checking that before leaving takes one call.

Finally, reopening creates a queue, and it is predictable in its size and in its composition. The next section is entirely about what that requires.

The queue the closure created

A closure does not remove demand, it postpones it. The first day back receives its normal load plus part of the closed days’, and it is almost always organised as a normal day.

The consequence is known to every practice: a saturated morning, a telephone that does not stop, and a team absorbing an entirely predictable peak.

What can be prepared comes down to two decisions taken before leaving. The first is to hold back a share of the first day’s slots from advance allocation — they will be taken in the first hours and they avoid sending everybody to the following week.

The second is to separate the two queues. Requests that arrived in writing during the closure can be handled calmly, in order, by somebody who is not on the phone. Handled in the same flow as incoming calls, they come after everybody although they arrived first.

That second decision is what gives meaning to the out-of-hours contact route described in section 4. Without it, the people who used the arrangement are penalised for having done so.

The person who cannot wait

This section is the shortest and that is deliberate, because almost anything else that could be added would go beyond what an article like this is entitled to say.

The rule that summarises it fits in one sentence: whoever answers a closed practice’s telephone is not the person who decides how serious anything is, and the arrangement must be designed so that they never have to.

Concretely, that means signposting to emergency services comes first on every surface, unconditionally, with no need to describe anything. Nobody should have to justify their condition to be given a number.

It also means that no form, no recorded message and no procedure of this practice asks anybody to describe symptoms in order to be signposted. A description obtained that way would be read by somebody with no business interpreting it, which is the worst of both worlds.

We will write no list of urgent situations and will publish none on any surface. That is a matter for clinical judgement and for health authority campaigns, and a practice circulating its own list creates exactly the risk it believes it is reducing.

Data during the absence

A closure produces traces: voicemail, written messages, notes taken by an answering service, sometimes requests sent through whatever channel.

Those traces contain health information, or look as though they do, and they end up in places nobody chose for the purpose — an operator’s voicemail, a secretary’s personal application, a consumer messaging thread.

The design rule that limits the problem is to reduce what is asked for. An appointment request form collecting a name, a way to call back and a preferred time creates no sensitive data; the same form with a free-text "reason" field creates some with every submission.

The second rule is to empty. What was collected during the closure is dealt with at reopening and then deleted from wherever it passed through, and that step belongs in the return procedure rather than being a separate project.

What health data regulation requires exactly is asked of somebody whose profession that is, and the neighbouring article already says so for patient records. What we add here is that a closure is when that data ends up in the least controlled places, precisely because nobody designed that period.

What is counted, and why adequacy is not a rate

Two things are counted, and they concern the arrangement rather than the people. The date the out-of-hours message was last re-recorded, and the date the hours on the business listing were last checked.

Those are dates and not quantities, and that is deliberate. They answer the only question this arrangement really poses: is what somebody meets at ten at night still true.

The figure we will not give is a volume of out-of-hours calls, nor a proportion of requests handled. The reason is not that it would be hard to obtain: it is that it does not measure the right kind of thing.

The adequacy of continuity is not read off a rate. An arrangement that correctly handles forty appointment requests and leaves the one person who needed signposting without it is not ninety-eight per cent effective: it missed the case it existed for.

That is why the two measures proposed concern the accuracy of what is published rather than the volume of what is handled. Correct signposting, available at any hour, is a state — and a state is true or false, not frequent.

What we do, and what we refuse to do

What we do is narrow: we write the text of the out-of-hours message in your patients’ languages, we put exact hours and closures on the business listing, and we set up a way to request an appointment outside hours that collects no reason.

We build no form, no message and no tool that asks anybody to describe a symptom. A description obtained that way is read by somebody with no business interpreting it, and we refuse that work even when it is asked for and even when it looks useful.

We draft no list of urgent situations and will publish none on any surface. That is a matter for clinical judgement and health authority campaigns; the signposting we write is unconditional and asks nobody to justify their condition.

We will not set up an outsourced answering service before what it records, where that goes and who can reach it are written down. A supplier who keeps messages holds health information, and that question is settled before the first call.

Finally, the two most useful actions in this article are free and take ten minutes: re-record the out-of-hours message with a reopening date, and check the hours on the business listing. They are also the only two things we will ask you to redo yourselves at every closure.

Frequently asked questions

What should the out-of-hours message contain?

Four things: exact hours, the reopening date if the closure is temporary, where to go in an emergency, and how to get an appointment. The second is the most often missing and the most sought after — "we are closed" does not answer the question being asked. And the emergency signposting points to a public arrangement, never a personal number.

Can a practice run a telephone on-call service?

It can provide signposting, which is a different thing. Continuity of care is organised by the structures provided for it, and letting people believe a practice is on call when it is not creates exactly the danger it claims to cover. What the person answering does is say what is open and what is not.

What may the person answering out of hours say?

A closed list: the hours, the reopening date, the existence of an appointment and its time, the address, and signposting to emergency services or the on-call facility. They ask no question about symptoms, do not note them, do not pass them on, and never say whether something is serious. The sentence to learn is: "I cannot answer that, and here is who can, now".

When should a closure be announced?

Four to six weeks ahead, on three surfaces — the business listing, the out-of-hours message and a note on the door — because patients do not use the same one. The listing is the forgotten one and the one people look at: normal hours displayed during a closure physically send patients to a locked door.

How do we absorb the reopening queue?

With two decisions taken before leaving. Hold back a share of the first day’s slots from advance allocation; and separate the two queues, so that requests arriving in writing during the closure are handled calmly by somebody who is not on the phone. Without the second, the people who used the arrangement come after everybody else.

How many out-of-hours calls do we get?

We do not give that figure and will set no target on it, because it does not measure the right kind of thing. An arrangement that correctly handles forty appointment requests and leaves the one person who needed signposting without it is not ninety-eight per cent effective: it missed the case it existed for. Measure two dates instead — the last re-recording of the message, and the last check of the hours.

Where we come in

Call your own practice after closing and listen to the end. What a patient hears at that moment is rarely what you believe you put in place.

We write what the answering machine says, in your patients’ languages.
We correct the hours everywhere they are published, not on one surface.
We say where to call in an emergency, without ever grading the emergency.

Deciding what counts as urgent belongs to a clinician: we will not write that list and we will publish it nowhere.

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