Anal fissures; first do no harm.

emergency centre staffed with GPs, nurse practitioners, and emergency medicine doctors. Handover between OOH and in-hours GPs has been defined as ‘one of the most perilous procedures in medicine, and when carried out improperly can be a major contributory factor to subsequent error and harm to patients’.1 In-hours care accounts for 50 hours/week while OOH care accounts for 118 hours/week. Handovers matter and should be quality-assured. How and when do in-hours providers check OOH providers’ reports? How often do in-hours providers act upon suggestions made by their OOH colleagues, provided suggestions are made. How confident are OOH providers that their in-hour colleagues will give timely attention and act upon the suggestions made? A common strategy adopted by OOH providers is to encourage patients to contact their practices and draw attention to the suggestions made by OOH providers. Is this safe enough? Is there scope for a quality assurance process applied to OOH handovers, and will this contribute towards forming a more effective OOH team?