Dear Dr Rant,
[Embarrassing praise for the blog edited out - blushing Ed.]
I returned from my Easter break to find a complaint in the practice post-bag.
Apparently the mother of a child who was unwell with earache on Good Friday had called the practice and been diverted through to NHS24 [the Scottish version of NHS Dire - Ed.]. They were then played a recorded message saying: "NHS 24 is busy. If it's not an emergency, please hang up.".
The parent called multiple times over a period of time, receiving the same message each time. Finally, she took the child in the car down to A&E.
Now, I don't need to tell you what kind of trouble I'd have been in as a GP pre-2004 if I'd put a message like this on my practice answering machine out of hours. The GMC would have taken a dim view in deed of such a shoddy, unprofessional, and dangerous practice.
However, now that we have our wonderful, much improved, better, New Labour paradise (and all at only several multiples of the cost of the old system) I can only assume that this shit service was a figment of the patient's imagination. Like all the other shit care that we 'imagine' every day.
Yours sincerely,
A Scottish GP
Too fucking true. Too fucking true.
Dr Rant
Dr Cardigan
Dr Blue
Dr Brown
Rev Dr Green
Dr Mustard
Mr Orange
Dr Pink
Dr Purple
Mr Salmon
Dr White
Mr Beige
Ms Scarlet
Dr Informed
8 comments:
As a humble Emergency Physician on call over the Easter weekend, I feel qualified to say that NHS Redirect was not operating any better south of the border!
As a GP doing an OOH shift on Good Friday I can confirm angrydoc's opinion. We had a nightmare as the computer system seemed to save up all the shit NHS Dire had been generating over the early morning, so we looked quiet, then it suddenly released a huge tsunami of excrementally bad "refer to GP" calls at once. It wasn't pretty....
'Finally, she took the child in a car down to A&E'.
Yet Wanless comments "it's hard to explain" why A&E attendences have risen by more than a third since 2004 - the year PCTs assumed responsibilty for OOH services (p5 of the report summary).
At the same time emergency admissions (via A&E) have gone up by 35% while the number of ambulance calls has doubled (over a 10 year period) to nearly 6million - and guess where most of these ambulances end up ?
A BMA survey (March 2005) concludes:
'Rather than focusing on the A&E department, attention needs to be on the whole area of unscheduled care. The aim should be the development of a COLLABORATIVE strategy from the local health economy, that is, primary, secondary and community care working TOGETHER to create a more efficient system that is better for patients'.
http://web.bma.org.uk/ap.nsf/Content/AandEwaiting
Ah, sound so simple doesn't it ?
"Yet Wanless comments "it's hard to explain" why A&E attendences have risen by more than a third since 2004 - the year PCTs assumed responsibilty for OOH services (p5 of the report summary)."
Yes, hard to explain. If you're an IDIOT.
Did it occur to anyone on the committee that the fact that so many OOH services are now so much more crap than they were might be something to do with it?
Okay, I ask as a layman...who actually staffs the OOH services given that the majority of GP practices have opted out because they wanted free time in the evenings? I would guess that none of the opted-out GPs would consider doing any of this work unless they were hypocrites.
That's a very interesting question.
In most areas it is the same GPs doing the work (ie: seeing the patients) as before. The difference is that the PCTs now organise the service.
This means that the GPs no longer have any real control over quality. They don't get to decide how many GPs need to be on to cover the work, how many primary care centers to operate out of, how telephone advice is handled, how many drivers are available, the standard of the premises, and so on.
Of course, the biggest problem is that the PCTs insist on using NHS Dire instead of the old system of the GPs themselves handling calls.
In other areas where deputising services were used in the past, the service may have improved. In many areas where there were excellent GP run 'co-operatives' the service has almost universally declined.
In many areas, to save money, the PCTs have reduced the number of doctors, increased the distance patients have to travel, increased the minimum response times, employed cheaper (less experienced/foreign) doctors, replaced doctors with nurses, and so on.
Does that answer your question?
I should add that many GP co-operatives (groups of GPs providing out of hours care to their own patients) were forced to close under the new contract.
This was done by a variety of means - political pressure, funding cuts, cheaper bids from private companies. In many areas local GPs stopped working in the new service because they refused to work in a dangerous clinical environment.
It's funny - doctors who refuse to take part in dangerous clinical cover are criticised for 'abandoning' patients while those that stay are criticised for being 'good nazis' that 'are just following orders'.
Re OOH service, Dr Rant explained: "In many areas, to save money, the PCTs have reduced the number of doctors, increased the distance patients have to travel, increased the minimum response times, employed cheaper (less experienced/foreign) doctors, replaced doctors with nurses, and so on."
Could Dr Rant be in any way forseeing the future with respect to the IN-hours service in Lord Dafti's much vaunted polyclinics?
Joe Public - be very afraid!!
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