At the British Medical Association conference, GP’s criticised the Government’s plans to replace NHS Direct with a new national ‘111’ service - a telephone service for patients with urgent but not life-threatening problems. They expressed concerns at the design of the scheme and not learning lessons from the evaluation of pilot schemes. They fear that lack of trained staff will lead to more referrals and poorer outcomes especially for vulnerable patients.
At the heart of this issue is how to balance the need of offering good quality medical advice at the first port of call with keeping cost down. All health services have some sort of ‘triage’ system - a way of identifying priorities and deciding which patients need urgent care and which do not. In Accident and Emergency departments a Nurse will normally see patients within minutes of their arrival and judge whether they need to see a Doctor, of what specialism and when. Not everyone with a health concern will necessarily need to see a GP and the system is one way of trying to avoid wasting GP time on unnecessary consultations. However, the risk is of increasing mistakes in Primary Care if poorly qualified staff are making what is a clinical judgment.
Our GP’s need every support in ensuring that they see the right patients and give the right advice. Common errors include failing to refer patients to Specialists and making mistakes in diagnosis. I have recently acted for the families of patients who died in one case after an 8 year delay in referring for investigations of a pre-cancerous bowel condition and in another where a GP failed to diagnose a fatal DVT.
Getting the triage system for primary care right is therefore a crucial issue and if our GPs are worried that the new system holds dangers for patients we should listen.
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