Why I don't offer an out-of-hours service
Plenty of private practices advertise a direct line, any time. I have decided not to, and I would rather explain that than let you find it out at two in the morning.
The promise fails on the night it matters
There is one of me. If I have promised twenty families that I will answer at three in the morning, I have promised something that depends entirely on my not being asleep, not being on holiday, not being ill, and not already being on the phone to somebody else's child. It holds perfectly until the night two families need me at once, which is precisely the night the promise was for.
A doctor who has been woken three times and is due to run a clinic at eight is not a doctor at his sharpest. I have done enough nights across twenty years to know what the fourth call does to clinical judgment. Selling you access to a tired doctor is not a premium service.
What the promise quietly does to the medicine
Availability is easy to sell and impossible to bound. Once a service is described in terms of when I answer rather than what your child gets, everything else follows from that. Consultations get shorter, because there are more of them. Home visits get requested rather than indicated. And the practice drifts back into being a faster version of what you already have.
Worse, an unbounded promise makes for defensive medicine. A doctor called at midnight about a child he has never examined, with no baseline and no record, will send that child in. Not because it is right, but because it is the only safe call available to him. The service that promised most delivered a car journey to an emergency department.
What the NHS does better
Overnight, seriously ill children need an emergency department with a paediatric team, imaging, blood gases, and a resuscitation bay. I cannot bring any of that to your house, and neither can anyone else charging you for the privilege. The NHS out-of-hours system and 111 exist, they are staffed by competent clinicians, and 999 will get you to the right place faster than I will.
If something cannot wait until morning, that is the route, and I say so to my own members. A doctor who tells you honestly what he cannot do is worth more than one who promises everything.
What I do instead
The night call is usually the end of a chain that started earlier in the day. A child gets a temperature at four in the afternoon. Nobody looks at them. By eleven the parents are frightened, because uncertainty grows in the dark.
So I break the chain earlier. Member families get a same-day assessment when a child is unwell, for requests before four in the afternoon on a working day, plus an evening triage window between six and eight. It is done by video, because what you assess in a sick child is their work of breathing, their hydration, their alertness, their rash, and the parent's own read on them. All of that comes down a camera. What cannot be assessed remotely gets seen in person, and a home visit is included when I judge it is needed.
Then I tell you exactly what this is, exactly what to watch for, and exactly which signs mean it needs more. A child seen at five, established as viral, with parents who know precisely what would change the picture, very rarely generates a call at eleven. That twenty seconds of safety-netting is the highest-value thing I do all day.
The boundary is the product
This reads as a reduction, and it is not. The alternative most families face is a two-week wait or four hours in an urgent treatment centre with a doctor who has never met their child.
What I offer is narrower and better. A doctor who has examined your children, who holds their history, and who can tell you today whether this needs more than reassurance. I can only make that offer honestly because I have written down what I do not do.