What is the German on-call medical service?

How the on-call service in Berlin is structured

The on-call medical service is the German health system's answer to the question: 'What do I do when my practice is closed?' Since GPs and specialists in Germany typically only offer consultations on weekdays between 8 am and 6 pm, about 70 percent of the week is unattended when acute symptoms occur. This gap is filled by two pillars: first, the statutory on-call service (the on-duty contracted physicians) reachable at the nationwide number 116117, free for GKV patients and staffed 24/7, offering phone triage, on-call practices and house calls by on-duty contracted physicians. Second, private on-call services organised by individual practices, physician networks or specialised providers, billable under GOÄ, faster, fee-based, primarily for privately insured patients and self-payers.

Both pillars complement the Berlin Fire Department rescue service (112), which is responsible for life-threatening emergencies. The division is clear: 112 for everything that is life-threatening (unconsciousness, chest pain, breathing failure, stroke, severe bleeding); 116117 or a private doctor for everything that is urgent but not life-threatening (fever, respiratory infection, GI infection, migraine, back pain, UTI). The statutory on-call service in Berlin is organised by KV Berlin, which maintains a pool of on-duty contracted physicians and on-call practices (e.g. at Charité Virchow, Vivantes Friedrichshain, Vivantes Spandau). Private on-call services are not centrally organised, various providers with different arrival times, language profiles and specialisations are available.

From a patient's perspective, the on-call service is what ensures care security outside practice hours, and in Berlin with its 3.7 million residents this security is not guaranteed. KV wait times are realistically long (4 to 8 hours in peak season), on-call practices are often crowded, the private route is faster but costs money. GKV patients who hold supplementary private insurance with a private-doctor tariff combine both worlds: free regular care via the statutory fund, and fast, thorough care outside practice hours via the supplementary policy. We give honest guidance on the phone, and clearly say so if 116117 or a hospital visit would be the financially or medically more sensible route.

Example: migraine attack on a Sunday evening

A Berliner in Wedding has a severe migraine attack with vomiting on a Sunday evening that does not respond to her usual self-care. Her GP is closed; 116117 quotes a callback in two hours. She chooses the private route, the doctor arrives in 75 minutes, performs a neurological examination, clinically rules out stroke, gives an intramuscular injection for pain and an antiemetic, and prescribes a triptan refill. Invoice 290 euros. Had she only had GKV cover without supplementary insurance, she would have carried the cost herself, or waited for 116117.

Pillars of the on-call service

• 112 Berlin Fire Department: life-threatening emergencies, ambulance and emergency physician, 8 – 15 minute arrival.
• 116117 statutory on-call service: urgent, non-life-threatening, free for GKV, 24/7.
• On-call practices in Berlin: Charité Virchow, Vivantes Friedrichshain, Vivantes Spandau and others, rotating opening hours.
• Private on-call services: GOÄ billing, faster than 116117, mainly for PKV and self-payers.
• GP practice hours in Berlin: typically 8 am – 6 pm on weekdays, some 7 am – 7 pm.
• Berlin on-call pharmacy: rotating 24/7 service, look up at www.akberlin.de or 0800 0022833.
• Poison hotline Berlin: 030 / 19240, call in parallel with 112 in case of suspected poisoning.
• Bereitschaftsdienst vs Notdienst: the terms are often used synonymously, both meaning out-of-hours medical care.